Thiamine Prescribing Practices for Adult Patients Admitted to an Internal Medicine Service

Alim, Uzma; Bates, Duane; Langevin, Ashten; Werry, Denise; Dersch‐Mills, Deonne; Herman, Robert J.; Mintz, Marcy; Ghosh, Sunita

doi:10.4212/cjhp.v70i3.1657

Cited by 11 publications

(15 citation statements)

References 23 publications

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“…A retrospective cohort conducted by Alim et al included both low-dose (defined as doses <100 mg) and high-dose (defined as doses >100 mg) IV thiamine prescribing patterns. 24 Of the 141 patients, only 17 of them were prescribed thiamine due to suspicion of WE. 24 For those suspected to have WE, 12 patients received high-dose thiamine.…”

Section: Resultsmentioning

confidence: 99%

Thiamine Dosing for the Treatment of Alcohol-Induced Wernicke’s Encephalopathy: A Review of the Literature

Smith

McCoy

Varughese

et al. 2020

Journal of Pharmacy Technology

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Objective: To determine the most appropriate thiamine replacement regimen by evaluating safety and efficacy of the drug specific to alcohol-induced Wernicke’s encephalopathy (WE). Data Sources: A comprehensive literature search was conducted using PubMed, MEDLINE, Scopus, and ProQuest between January and August 2020 using the following keyword and Boolean search terminology: “thiamine” AND “alcohol” AND (encephalopathy OR korsakoff). Study Selection and Data Extraction: Randomized control trials; prospective, observational, and retrospective cohort analyses; and case reports and series were included in this evaluation. A confirmed diagnosis of alcohol-induced WE and treatment with parenteral or intramuscular (IM) thiamine were required for inclusion. Data Synthesis: Six publications composed of 138 patients were evaluated in this review, in which a wide variety of thiamine supplementation strategies were employed. Clinical diagnostic criteria varied significantly between publications. Doses ranged from 100 to 1500 mg intravenous thiamine and up to 300 mg IM thiamine, with no apparent difference in patient outcomes. All patients who received thiamine experienced symptom improvement, and adverse drug events were minimal. Conclusions: Despite the clinical controversy regarding the appropriate thiamine supplementation regimen, the heterogeneity of published works combined with symptom resolution across the gamut of dosing strategies makes a definitive consensus elusive. Clinicians should continue to provide parenteral or IM thiamine in doses of ≥100 mg to patients with confirmed alcohol-induced WE.

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Section: Resultsmentioning

confidence: 99%

Thiamine Dosing for the Treatment of Alcohol-Induced Wernicke’s Encephalopathy: A Review of the Literature

Smith

McCoy

Varughese

et al. 2020

Journal of Pharmacy Technology

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“…43 Efforts are also needed to understand the factors that underlie the strong preference for 1-time or once-daily dosing of thiamine noted within our hospital network and elsewhere. 1,19 Although most studies to date have considered the impact of a single intervention on prescribing practices, future studies are needed to assess the effect of multifaceted approaches integrating changes to order entry systems together with educational approaches targeting specific services and prescribing patterns.…”

Section: Openmentioning

confidence: 99%

“…[12][13][14][15][16] Despite these recommendations, observational studies consistently report low rates of prescribing of parenteral treatment within academic hospitals. 1,9,17,18 When parenteral thiamine therapy is prescribed, the dosages and duration of treatment are often below those recommended, 1,[18][19][20] exposing vulnerable patients to risks of irreversible brain injury and death. 7,8,21,22 A prior attempt to alter prescribing practices using a cost-and effort-intensive strategy (direct pharmacist intervention) failed to alter prescriber behaviour substantially.…”

mentioning

confidence: 99%

Improving thiamine prescribing at an academic hospital network using the computerized provider order entry system: a cohort study

Day

Ladak

Campo

2020

cmajo

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Background: Oral thiamine therapy is frequently prescribed to patients at risk for thiamine deficiency despite recommendations emphasizing the need for high doses of parenteral thiamine to reverse brain thiamine deficits. We evaluated the effect of changes to the computerized provider order entry system on the proportion of prescriptions for parenteral thiamine treatment (primary outcome) and dosages prescribed (secondary outcome) within our academic hospital network. Methods: We obtained data from the pharmacy information system recording thiamine prescribed to inpatients at University Health Network hospitals (Toronto, Ontario) before (Jan. 1, 2010, to Dec. 31, 2011) and after (Nov. 21, 2013, to Apr. 30, 2017) changes to the computerized provider order entry system promoting the use of higher dosages (≥ 200 mg) of parenterally administered thiamine. Patients receiving thiamine as part of total parenteral nutrition were excluded from analyses, as thiamine prescribing was automated and unlikely to be affected by the intervention. Results: A total of 6105 thiamine prescriptions were written for 2907 patients before the intervention and 12 787 thiamine prescriptions for 8032 patients after the intervention. The proportion of prescriptions for parenteral treatment increased from 55.5% (3386/6105) to 92.5% (11 829/12 787) after the intervention (p < 0.001). Increases in prescribing of parenteral thiamine treatment were sustained or enhanced across the 3.4-year observation period and were realized across all hospital services. Prescriptions for higher dosages of thiamine increased from 1.1% (65/6105) to 61.4% (7845/12 787) after the intervention (p < 0.001). Interpretation: Changes to the computerized provider order entry system were associated with sustained increases in the proportion of prescriptions for high-dose parenteral thiamine therapy. Similar approaches may be leveraged to align prescriber behaviour with well-accepted practice parameters in other areas of medicine.

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“…In addition, liver cirrhosis, a complication of chronic alcoholism, also leads to a decreased supply of thiamin to the liver . Postmortem studies have shown that the prevalence of Wernicke's encephalopathy, one of the clinical features of thiamin deficiency, among patients with alcoholism varies from 12.5% to 35%, whereas the prevalence of this encephalopathy in the general population is 1.5% …”

Section: Risk Factors For Thiamin Deficiencymentioning

confidence: 99%

Role of Thiamin in Health and Disease

et al. 2019

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Thiamin is a hydrosoluble vitamin that plays a role in several biological processes, mainly in glucose metabolism. There are several risk factors for developing thiamin deficiency, such as malnutrition, refeeding syndrome, gastrointestinal surgery, and alcoholism. Recently, the role of thiamin in critically ill patients has gained prominence, and the prevalence of thiamin deficiency was found to be increased in patients with severe burns, major surgery, septic shock, end-stage renal disease, and heart failure. In adults, thiamin deficiency presents as encephalopathy, dry beriberi (with neurological signs and symptoms), or wet beriberi (with cardiovascular signs and symptoms). Thiamin deficiency can be diagnosed clinically, and all clinicians should be aware of this disease, especially in patients with risk factors for thiamin deficiency. Thiamin supplementation should be started as early as possible in patients suspected to have thiamin deficiency. Treatment is safe, inexpensive, simple, and life-saving. Diagnosis is confirmed on a positive response to treatment. (Nutr Clin Pract. 2019;34:558-564)

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Thiamine Prescribing Practices for Adult Patients Admitted to an Internal Medicine Service

Abstract: Background: Thiamine (vitamin B 1 ) is an essential cofactor responsible for the breakdown of glucose, and its deficiency is associated with Wernicke encephalopathy (WE). There is a lack of evidence from systematic studies on the optimal dosing of thiamine for WE.

Cited by 11 publications

References 23 publications

Thiamine Dosing for the Treatment of Alcohol-Induced Wernicke’s Encephalopathy: A Review of the Literature

Thiamine Dosing for the Treatment of Alcohol-Induced Wernicke’s Encephalopathy: A Review of the Literature

Improving thiamine prescribing at an academic hospital network using the computerized provider order entry system: a cohort study

Role of Thiamin in Health and Disease

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