Severe thiamine deficiency resulted in Wernicke's encephalopathy in a chronic dialysis patient

Ueda, Kae; Takada, Daisuke; Mii, Akiko; Tsuzuku, Y; Saito, Sabine Kyoko; Kaneko, Takeshi; Utsumi, Kouichi; Iino, Yuichi; Katayama, Yasuo

doi:10.1007/s10157-006-0440-9

Cited by 34 publications

(11 citation statements)

References 3 publications

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“…However, the mean thiamine level was lower in the extended hours group. Given the low risk of thiamine supplementation, and the severe consequences of Wernicke' s encephalopathy, cases of which still appear in the in dialysis literature, 39 supplementation as part of a multivitamin is reasonable for all hemodialysis patients. No difference between the groups in folate levels was identified, but this may be secondary to the use of supplements.…”

Section: Key Resultsmentioning

confidence: 99%

Water‐soluble vitamin levels in extended hours hemodialysis

Coveney

Polkinghorne

Linehan

et al. 2010

Hemodialysis International

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Patients on extended hours (>15 h/week) hemodialysis may be at a higher risk of deficiency of water-soluble vitamins than conventional (≤15 h/week) hemodialysis patients due to their increased weekly hours of dialysis. We compared serum levels of the water-soluble vitamins in a group of extended and conventional hours hemodialysis patients. Predialysis serum levels of vitamin C, vitamin B12, thiamine, pyridoxine, and folate were measured in 52 patients: 26 extended group and 26 conventional group. Information on patient's intake of vitamin supplements and dialysis regimen was obtained. Data were log transformed due to the skewed distribution of the results. Median vitamin C levels were significantly lower in the extended group (0.30 vs. 1.14 mg/dL, P<0.001), with 7 patients having a level <0.18 mg/dL. Thiamine levels were also lower in the extended group (median 211 vs. 438.5 nmol/L, P=0.0005). However, extended patients had higher levels of pyridoxine (23.2 vs. 11.1 ng/mL, P=0.03). Vitamin B12 and folate levels were not significantly different between the groups. There was significant variability in vitamin supplement prescription in both groups, and dietary data were not obtained. This study showed a high incidence of vitamin C deficiency in extended hours hemodialysis patients, suggesting that supplementation is warranted. It also supports an ongoing role for multivitamin supplementation in conventional hemodialysis patients.

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Section: Key Resultsmentioning

confidence: 99%

Water‐soluble vitamin levels in extended hours hemodialysis

Coveney

Polkinghorne

Linehan

et al. 2010

Hemodialysis International

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“…Alcoholism is not directly responsible for vitamin B1 deficiency; its effects are related to the complications of liver cirrhosis such as problems to the gastrointestinal tract with low absorption rate at the mucosal level and consequent malnourishment [12]. Apart from alcohol, a lot of other conditions causing malnutrition and decreased thiamine absorption such as gastrointestinal surgical procedures (including gastric bypass surgery, gastrojejunostomy, gastrectomy, and colectomy) [13–18], therapy with intragastric balloon [19], hyperemesis gravidarum [20, 21], terminal tumor [22], chemical therapy [23, 24], allogenic stem cell transplantation [25], AIDS [26], anorexia nervosa [27], fasting [28], starvation [29], hemodialysis [30], pancreatitis [31], wrong formula feeding [32], parenteral nutrition, hyperalimentation [33, 34], and prolonged intravenous glucose infusion [35] have been reported as predisposing factors.…”

Section: Aetiopathogenesismentioning

confidence: 99%

MR Imaging Findings in Alcoholic and Nonalcoholic Acute Wernicke’s Encephalopathy: A Review

Manzo

Gennaro

Cozzolino

et al. 2014

BioMed Research International

127

138

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Wernicke's encephalopathy (WE) is a severe neurological syndrome caused by thiamine (vitamin B1) deficiency and clinically characterized by the sudden onset of mental status changes, ocular abnormalities, and ataxia. Apart from chronic alcoholism, the most common cause of WE, a lot of other conditions causing malnutrition and decreasing thiamine absorption such as gastrointestinal surgical procedures and hyperemesis gravidarum must be considered as predisposing factors. Due to its low prevalence and clinical heterogeneity, WE is often misdiagnosed, leading to persistent dysfunctions and, in some cases, to death. Nowadays, MR imaging of the brain, showing T2 and FLAIR hyperintensities in typical (thalami, mammillary bodies, tectal plate, and periaqueductal area) and atypical areas (cerebellum, cranial nerve nuclei, and cerebral cortex), is surely the most important and effective tool in the diagnostic assessment of WE. The aim of this paper is to propose a state of the art of the role of MR imaging in the early diagnosis of this complex disease.

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“…However, the difference between the two groups was highly significant with regard to vitamin B1 intake, with only 8% and 50% of patients with a sodium intake <1500 or ≥1500 mg within the target value, respectively. Low vitamin B1 intake can lead to low serum levels and associated complications as Wernicke's encephalopathy [41,42].…”

Section: Discussionmentioning

confidence: 99%

Dietary Daily Sodium Intake Lower than 1500 mg Is Associated with Inadequately Low Intake of Calorie, Protein, Iron, Zinc and Vitamin B1 in Patients on Chronic Hemodialysis

et al. 2020

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Background: To measure daily sodium intake in patients on chronic hemodialysis and to compare the intake of nutrients, minerals, trace elements, and vitamins in patients who had a daily sodium intake below or above the value of 1500 mg recommended by the American Heart Association. Methods: Dietary intake was recorded for 3 days by means of 3-day diet diaries in prevalent patients on chronic hemodialysis. Each patient was instructed by a dietitian on how to fill the diary, which was subsequently signed by a next of kin. Results: We studied 127 patients. Mean sodium intake (mg) was 1295.9 ± 812.3. Eighty-seven (68.5%) patients had a daily sodium intake <1500 mg (group 1) and 40 (31.5%) ≥ 1500 mg (group 2). Correlation between daily sodium intake and daily calorie intake was significant (r = 0.474 [0.327 to 0.599]; p < 0.0001). Daily calorie intake (kcal/kg/day) was lower in group 1 (21.1 ± 6.6; p = 0.0001) than in group 2 (27.1 ± 10.4). Correlation between daily sodium intake and daily protein intake was significant (r = 0.530 [0.392 to 0.644]; p < 0.0001). The daily protein intake (grams/kg/day) was lower in group 1 (0.823 ± 0.275; p = 0.0003) than in group 2 (1.061 ± 0.419). Daily intake of magnesium, copper, iron, zinc, and selenium was significantly lower in group 1 than in group 2. Daily intake of vitamin A, B2, B3, and C did not differ significantly between group 1 and group 2. Daily intake of vitamin B1 was significantly lower in group 1 than in group 2. Significantly lower was, in group 1 than in group 2, the percentage of patients within the target value with regard to intake of calories (11.5% vs. 37.5%; p = 0.001) and proteins (9.2% vs. 27.5%; p = 0.015) as well as of iron (23% vs. 45%; p = 0.020), zinc (13.8% vs. 53.8%; p = 0.008) and vitamin B1 (8.1% vs. 50%; p < 0.001). Conclusion: A low daily intake of sodium is associated with an inadequately low intake of calorie, proteins, minerals, trace elements, and vitamin B1. Nutritional counselling aimed to reduce the intake of sodium in patients on chronic hemodialysis should not disregard an adequate intake of macro- and micronutrients, otherwise the risk of malnutrition is high.

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Severe thiamine deficiency resulted in Wernicke's encephalopathy in a chronic dialysis patient

Cited by 34 publications

References 3 publications

Water‐soluble vitamin levels in extended hours hemodialysis

Water‐soluble vitamin levels in extended hours hemodialysis

MR Imaging Findings in Alcoholic and Nonalcoholic Acute Wernicke’s Encephalopathy: A Review

Dietary Daily Sodium Intake Lower than 1500 mg Is Associated with Inadequately Low Intake of Calorie, Protein, Iron, Zinc and Vitamin B1 in Patients on Chronic Hemodialysis

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