‘’ I never forget to dose my malnourished and alcoholic patients with thiamine after seeing a true case of Wernicke's Encephalopathy in medical school. The patient was a 38 year old women who initially presented to neurology clinic with a chief complaint of burning pain in her legs and gait instability. They diagnosed her with GBS after a nerve conduction study and then even admitted her to the hospital twice for IVIG infusions without any real progress. She later presented to the ED unresponsive and was admitted to the ICU. After a brain MRI revealed necrosis of both mamillary bodies the diagnosis was clear. After the fact, friends and family endorsed that the patient was a heavy drinker and had been struggling with alcoholism for years. Strangely enough, her B12 and folate levels were within the reference range, so the neurologists treating her dismissed the idea of malnutrition as a cause of her symptoms. I'm not sure that they knew the extent of her drinking. Care was withdrawn about a week after her admission to the neuroscience ICU and she died shortly after extubation. This woman became a vegetable for want of a cheap and readily available therapy. In my mind there is little to lose and much to gain by empirically treating all alcoholics and malnourished patients with thiamine if they complain of any neurological symptoms what-so-ever. Wernicke rarely presents with the classic triad and there are many other symptoms associated with it other than ophthalmoplegia, ataxia, and encephalopathy. Don't let your patient's brain turn to mush because you don't want to look foolish by ordering a therapy empirically. Thiamine is cheap, brains are invaluable.‘’ truly UNFORGIVABLE that medical institutions have not educated the public on thiamine. Why do we know about glucose, potassium, and sodium but not about thiamine? Why are we taught about how to identify a heart attack but not that we should eat foods high in thiamine?
I was confused by the cake and ice cream. Thanks for saying this part to fill in the gaps.. yes give her steak pref grass fed, covered in grass fed butter! I think that House mentioned alcoholism or malnutrition probably the second. I’m actually struggling with hair and just started on B1 yesterday already noticing that it is less severe.
B complex tends to do that and can turn your pee a bright, almost neon yellow color. The most common culprit is vitamin B2 - riboflavin. B vitamins are water soluble so are excreted in urine ( excess)
Thankyou doc .became a heavy drinker after people close died but coffee doesn't help either, tannins use up b vitimins .so i am down t one or two cups and ketvore . This is very important .
Apparently, I have a thiamine deficiency, I've been taking 1000mg every day for over 2 weeks now with no effect. I Also pair it with magnesium and a B complex. How long does Thiamine take to work?
It depends on the severity of the condition being treated. If it's supplementation only for prevention oral is ok. If their are absorption problems IM OR iV may be needed. Thiamine works immediately. What is the effect expected? I.e what is being treated? Your doctor is in the best position to advise if parenteral route is needed. Wish you well
@Andmaj Yea, it worked pretty good for my bad digestive track, but other than that, I see no results. I suspect I have some sort of parasitic, if not viral infection
Hello sir pls help me with this. I have racing thoughts pins and needles and I have anxiety and I don't have the calmness in my mind and I don't feel clear in my mind nd also i don't feel grounded I feel like I m floating around don't feel in present moment. Tingling nerves and mood very off. Also digestion not good. And nerves also pain sometimes
If you are a drinker quit and take benfotiamin. If you under eat also Take IT and also,B12,Magnesium and fish oil and so on. Also to calm your nerves camomille works Wonders. But again alcohol and drugs in General can BE EVIL.
Of course - it is available. Pabrinex Pabrinex® Intravenous High Potency Injection (Archimedes Pharma UK Ltd) is the only IV preparation of thiamine marketed in the UK and it is presented as two ampoules. www.medicines.org.uk/emc/product/1427/smpc#gref
It depends on if thiamine is the main cause . If other causes are present then thiamine supplementation becomes a component of overall treatment rather the only treatment
This is a patient with eating disorder. Treatment is nutritional rehabilitation. So while thiamine deficiency is part of the anterograde amnesia and confabulation, starvation as part of ED will lead to further widespread cognitive impact.
