Thiamine Status in Alcoholism

Abstract

Summary :Thiamine status in alcoholism. Beverley Wood, Kerry J. Breen and D. G. Penington, Aust. N.Z. J. Med., 1977, 7, pp. 475–484. The erythrocyte transketolase assay was used to seek biochemical evidence of thiamine deficiency in 265 alcoholic persons attending an inner city Australian hospital. Fifty patients were found to have recent vitamin therapy and were excluded from further study. Wernicke's encephalopathy was diagnosed in 24 subjects (11.3%). The thiamine pyrophosphate (TPP) effect was elevated in only 13 of the 24 patients with Wernicke's encephalopathy; a much closer correlation was observed with erythrocyte transketolase activity which was depressed in 21 persons with this diagnosis. Low erythrocyte transketolase activity (32.6%) was more frequently seen than an elevated TPP effect (24-7%) in the overall group of 215 subjects. Of 47 patients with a low erythrocyte transketolase activity which failed to return to normal after the addition of TPP in vitro, only ten patients had liver disease. Twelve patients with Wernicke's encephalopathy studied following thiamine hydrochloride in vivo showed complete biochemical response despite the presence of biopsy proven severe liver disease in two patients and the lack of response of low erythrocyte transketolase activity to TPP in vitro in eleven of the twelve patients. Fiftyfive patients were studied before and after thiamine in vivo. Seventeen of these subjects had severe liver disease but only two of the 17 had low ETKA which failed to respond to TPP in vitro; both responded biochemically to thiamine hydrochloride in vivo. In the remaining 38 patients without evidence of severe liver disease, 14 had low ETKA which failed to return to normal with TPP in vitro; three of these failed to respond biochemically to thiamine hydrochloride in vivo. These data indicated that apparent deficiency of erythroc yte apotransketolase was infrequently linked with the presence of liver disease and that liver disease did not appear to interfere with the biochemical response to thiamine in vivo. Urinary thiamine excretion measured in 79 subjects did. not correlate with any means of expression of the transketolase assay or with clinical thiamine deficiency. It was concluded that the TPP effect was frequently misleading in subjects with gross thiamine deficiency (Wernicke'S encephalopathy) and it was suggested that erythrocyte transketolase activity may be the best parameter to use in assessing thiamine status with the erythrocyte transketolase assay. Finally, it is postulated that severe thiamine deficiency per se may lead to deficiency of erythrocyte apotransketolase which has been previously ascribed to liver damage.