Abstract

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.

Highlights

  • Alcohol withdrawal syndrome (AWS) is routinely treated with B-vitamins

  • We recently reported in a retrospective study that patients who experienced an episode of alcohol withdrawal syndrome received thiamine supplementation thiamine diphosphate (TDP) concentrations were not determined

  • All patients (n = 127) recruited to the study fulfilled the criteria for inclusion with age, sex, body mass index (BMI) and documented evidence of alcohol withdrawal syndrome

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Summary

Introduction

Alcohol withdrawal syndrome (AWS) is routinely treated with B-vitamins. the relationship between thiamine status and outcome is rarely examined. The aim of the present study was to examine the relation‐ ship between thiamine and magnesium status in patients with AWS. In the USA, the number of alcohol related deaths is reported to have increased by 35% between 2007 and 2017 [4], while Scotland is reported to have the highest alcohol related death rate in the UK [5]. Despite these recent epidemiological reports, there is a paucity of data available in the literature related to mortality for patients following an episode of alcohol withdrawal syndrome (AWS) [6]. The occurrence of alcohol withdrawal syndrome (AWS) may represent the crossing of that threshold [9]

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