The effect of thiamine and/or magnesium supplementation on thiamine, magnesium, lactate and erythrocyte transketolase activity in patients presenting to the emergency department with alcohol withdrawal syndrome

Maguire, Donogh; McMillan, D.C.; Stefanowicz, Fiona; Burns, Alana M.; Ross, David P.; Talwar, Dinesh

doi:10.1016/j.clnu.2018.06.1128

Cited by 2 publications

(4 citation statements)

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“…a pseudo-hypoxic ‘dirty burn’ (Fig. 2) [7]. Given the requirement of PDH for TDP and magnesium, chronic ingestion of excessive amounts of alcohol in the context of a micronutrient poor diet may therefore result in pseudo-hypoxic dysregulation of glucose metabolism (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Alcohol exerts direct and indirect effects on cellular energy metabolism and alcohol use disorder (AUD) is a complex psychological and pathophysiological problem [7, 8]. Nutritional and social factors may be protective or contributory, however a threshold may be reached beyond which alcohol related compromise of oxidative resilience manifests in accelerated organ/system specific final common pathways of biochemical and clinical deterioration [7, 9]. The occurrence of alcohol withdrawal syndrome (AWS) may represent the crossing of that threshold [9].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, in the context of normal partial pressure tissue oxygen concentrations and in the absence of an inflammatory response or intense skeletal muscle activity (e.g. alcohol withdrawal seizure), thiamine and/or magnesium deficiency mediated increase in metabolism of glucose to lactate may represent pseudo-hypoxic disruption of normal glucose metabolism [7, 20].

Fig.…”

Section: Introductionmentioning

confidence: 99%

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A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome

et al. 2019

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BackgroundAlcohol withdrawal syndrome (AWS) is routinely treated with B-vitamins. However, the relationship between thiamine status and outcome is rarely examined. The aim of the present study was to examine the relationship between thiamine and magnesium status in patients with AWS.MethodsPatients (n = 127) presenting to the Emergency Department with AWS were recruited to a prospective observational study. Blood samples were drawn to measure whole blood thiamine diphosphate (TDP) and serum magnesium concentrations. Routine biochemistry and haematology assays were also conducted. The Glasgow Modified Alcohol Withdrawal Score (GMAWS) measured severity of AWS. Seizure history and current medications were also recorded.ResultsThe majority of patients (99%) had whole blood TDP concentration within/above the reference interval (275–675 ng/gHb) and had been prescribed thiamine (70%). In contrast, the majority of patients (60%) had low serum magnesium concentrations (< 0.75 mmol/L) and had not been prescribed magnesium (93%). The majority of patients (66%) had plasma lactate concentrations above 2.0 mmol/L. At 1 year, 13 patients with AWS had died giving a mortality rate of 11%. Male gender (p < 0.05), BMI < 20 kg/m2 (p < 0.01), GMAWS max ≥ 4 (p < 0.05), elevated plasma lactate (p < 0.01), low albumin (p < 0.05) and elevated serum CRP (p < 0.05) were associated with greater 1-year mortality. Also, low serum magnesium at time of recruitment to study and low serum magnesium at next admission were associated with higher 1-year mortality rates, (84% and 100% respectively; both p < 0.05).ConclusionThe prevalence of low circulating thiamine concentrations were rare and it was regularly prescribed in patients with AWS. In contrast, low serum magnesium concentrations were common and not prescribed. Low serum magnesium was associated more severe AWS and increased 1-year mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fig.…”

Section: Introductionmentioning

confidence: 99%

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A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome

et al. 2019

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“…Magnesium absence, therefore, may result in altered metabolism of glucose and increased lactate production (39). Hence, in clinical practice, the correction of concomitant magnesium deficiency is essential to thiamine utilization, although it is often overlooked (40,41).…”

Section: Thiamine: Functions and Mechanisms Of Actionmentioning

confidence: 99%

Insights Into Thiamine Supplementation in Patients With Septic Shock

et al. 2022

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Septic shock is associated with unacceptably high mortality rates, mainly in developing countries. New adjunctive therapies have been explored to reduce global mortality related to sepsis. Considering that metabolic changes, mitochondrial dysfunction and increased oxidative stress are specific disorders within the path of septic shock, several micronutrients that could act in cellular homeostasis have been studied in recent decades. Thiamine, also known as vitamin B1, plays critical roles in several biological processes, including the metabolism of glucose, synthesis of nucleic acids and reduction of oxidative stress. Thiamine deficiency could affect up to 70% of critically ill patients, and thiamine supplementation appears to increase lactate clearance and decrease the vasopressor dose. However, there is no evident improvement in the survival of septic patients. Other micronutrients such as vitamin C and D, selenium and zinc have been tested in the same context but have not been shown to improve the outcomes of these patients. Some problems related to the neutrality of these clinical trials are the study design, doses, route, timing, length of intervention and the choice of endpoints. Recently, the concept that multi-micronutrient administration may be better than single-micronutrient administration has gained strength. In general, clinical trials consider the administration of a single micronutrient as a drug. However, the antioxidant defense is a complex system of endogenous agents in which micronutrients act as cofactors, and the physiological interactions between micronutrients are little discussed. In this context, the association of thiamine, vitamin C and corticoids was tested as an adjunctive therapy in septic shock resulting in a significant decrease in mortality. However, after these initial results, no other study conducted with this combination could reproduce those benefits. In addition, the use of low-dose corticosteroids is recommended in patients with septic shock who do not respond to vasopressors, which can affect the action of thiamine. Therefore, given the excellent safety profile, good biologic rationale and promising clinical studies, this review aims to discuss the mechanisms behind and the evidence for single or combined thiamine supplementation improving the prognosis of patients with septic shock.

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The effect of thiamine and/or magnesium supplementation on thiamine, magnesium, lactate and erythrocyte transketolase activity in patients presenting to the emergency department with alcohol withdrawal syndrome

Cited by 2 publications

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A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome

A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome

Insights Into Thiamine Supplementation in Patients With Septic Shock

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