Pharmacology
Fluids and Electrolytes
A 64 year old man, with a history of chronic alcohol abuse, presents to ED in alcohol withdrawal as he ran out of beer money. He is unkempt and malnourished. The alcohol nurse is concerned about his risk of Wernicke-Korsakoff syndrome. Which of the following would be most appropriate to prescribe this patient:
Answer:
The severe deficiency states Wernicke’s encephalopathy and Korsakoff’s psychosis, especially as seen in chronic alcoholism, are best treated initially by the parenteral administration of B vitamins (Pabrinex®), followed by oral administration of thiamine in the longer term.Management of Thiamine Deficiency
Pharmacology / Fluids and Electrolytes
Last Updated: 27th March 2019
Deficiency of the B vitamins, other than vitamin B12, is rare in the UK and is usually treated by preparations containing thiamine (B1), riboflavin (B2), and nicotinamide.
The severe deficiency states Wernicke’s encephalopathy and Korsakoff’s psychosis, especially as seen in chronic alcoholism, are best treated initially by the parenteral administration of B vitamins (Pabrinex®), followed by oral administration of thiamine in the longer term.
Administration
For prophylaxis of Wernicke's encephalopathy 1 pair of ampoules of Pabrinex I/V high Potency are given once daily for at least 3 – 5 days by intravenous infusion or deep muscular injection.
Oral thiamine should be continued long-term in harmful drinkers if they are malnourished or at risk of malnourishment or if they have decompensated liver disease.
CHM Advice
Although potentially serious allergic adverse reactions may rarely occur during, or shortly after, parenteral administration of thiamine, the CHM has recommended that:
- this should not preclude the use of parenteral thiamine in patients where this route of administration is required, particularly in patients at risk of Wernicke-Korsakoff syndrome where treatment with thiamine is essential
- intravenous administration should be by infusion over 30 minutes
- facilities for treating anaphylaxis should be available when parenteral thiamine is administered
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
