Serum Thiamine Level Research Articles

Thiamine supplementation increases serum thiamine and reduces pyruvate and lactate levels in burn patients

The importance of vitamins for optimal metabolism is well established. However, currently little is known about the optimal vitamin levels required for burn patients. As a consequence, current practice both for macronutrient supplementation and vitamin supplementation varies widely between burn units. A better understanding of the effects of vitamins on metabolism may lead to better nutrition and subsequently improved outcomes for burn patients. Thiamine is an important co-factor required for multiple enzymes involved in carbohydrate metabolism. We have examined the levels of thiamine (B1) in burn patients as well as the effects of thiamine supplementation on the levels of serum thiamine, pyruvate and lactate. Twenty patients had blood samples taken on the day of admission, then on days 1, 3, and 7 post-admission and weekly thereafter until discharge. Of these, nine received enteral feeding. Six patients received thiamine supplementation. Serum thiamine, pyruvate and lactate levels were measured at each time point. Serum thiamine levels increased significantly with thiamine supplementation ( p < 0.001). Serum thiamine levels also increased with time of supplementation ( p < 0.001). Serum thiamine level was closely associated with pyruvate and lactate levels, with a decrease in both pyruvate and lactate associated with increased serum thiamine. Lastly, pyruvate and lactate levels appear closely associated in a linear relationship. This study suggests thiamine supplementation increases serum thiamine and that this increase is associated with a decrease in pyruvate and lactate levels. Further study of changes in metabolic flux associated with thiamine supplementation and a randomised control trial of thiamine supplementation are required to establish whether thiamine supplementation is beneficial to burn patients’ metabolism and recovery.

Serum Thiamine Level in Pregnant and Non-Pregnant Women in Zaria, Nigeria

Serum Thiamine Level in Pregnant and Non-Pregnant Women in Zaria, Nigeria

Decreased thiamine and magnesium levels in the potentiation of the neurotoxicity of lead in occupational lead exposure

The relationship between blood lead (Pb) and serum levels of calcium and of neural nutrients such as thiamine and magnesium (Mg) has been determined in a Nigerian population that is occupationally exposed to Pb. Forty-seven male Pb workers were recruited as test subjects and 25 males unexposed to Pb served as controls. The test subjects were classified into three groups, based on severity of exposure to Pb. Blood lead (BPb) and the serum levels of Mg, thiamine, and calcium were determined in both test subjects and controls. The mean blood Pb level was not significantly higher in Pb workers. In contrast, Mg and thiamine levels were significantly decreased (p<0.05; p<0.01, respectively). However, the calcium level was not significantly lower in test subjects than in controls. Also, there was a significant negative correlation between serum thiamine and blood Pb levels (r=-0.50; p<0.01). Furthermore, there was a significant negative correlation between serum calcium and BPb levels (r=-0.41; p<0.01). This study has shown that relatively low BPb levels can enhance Pb absorption and also potentiate Pb neurotoxicity in the presence of decreased serum thiamine and Mg levels.

Severe thiamine deficiency resulted in Wernicke's encephalopathy in a chronic dialysis patient

A 64-year-old male patient with diabetic nephropathy had been treated with maintenance hemodialysis therapy for 4 years, and had developed disturbed consciousness. The disturbance was firstly noticed by a primary care doctor who recognized slow responses in conversation. Prior to developing this symptom, the patient had noticed a loss of appetite for about 2 weeks. During a period of observation at an outpatient clinic, the symptoms became worse. He was admitted to a primary care hospital for 10 days, but his consciousness level deteriorated and he became unconscious (JCS 200). About 1 month after the onset of symptoms, the patient was transferred to our hospital. A brain computed tomography (CT) scan and magnetic resonance imaging (MRI) showed typical abnormal lesions in the aquaduct of the midbrain and thalamus, and a diagnosis of Wernicke's encephalopathy was made. In addition, the patient's serum thiamine level was extremely low (7 ng/ml). He received immediate treatment with intravenous thiamine administration (150 mg/day), and this significantly improved his symptoms (JCS 2). Dialysis patients may develop water-soluble vitamin deficiency as a result of the combination of reduced oral intake and increased loss of vitamins into the dialysate. Wernicke's encephalopathy should be considered as one of many causes of disturbed consciousness in hemodialysis patients. A rapid diagnosis and adequate treatment are essential in order to minimize long-term neurological sequelae.

Preparation and Characterization of (5-Methyl-2-oxo-1,3-dioxol-4-yl) methyl Thiamine Sulfides

A new type of S-protected thiol-type thiamines (prodrugs), which have a (5-methyl-2-oxo-1,3-dioxol-4-yl) methyl group recognized as a biologically safe promoiety, were designed, prepared, and confirmed to show higher serum thiamine levels after oral administration to rats than after that of thiamine itself and bisbentiamin as standards. Thus it was shown that the promoiety should be also used for improvement of poor oral absorption of drugs with a mercapto group, in addition to the absorption of drugs with carboxyl, amino, and hydroxyl groups.

Wernicke encephalopathy presented in the form of postoperative delirium in a patient with hepatocellular carcinoma and liver cirrhosis: A case report and review of the literature

Although Wernicke encephalopathy has been reported in the oncological literature, it has not previously been reported in postoperative cancer patients. In this communication, we report a patient of hepatocellular carcinoma with liver cirrhosis who developed Wernicke encephalopathy in the form of postoperative delirium. Preoperatively, the patient had a very good appetite and had eaten all the food of an 1800 cal/day diet until 1 day before operation. The operation was done without any complications. The patient developed delirium 2 days after the lobectomy of the liver. The level of delirium remained unchanged until administration of thiamine starting on day 7 postoperatively, which resulted in palliation of delirium without brain damage. Laboratory data demonstrated that the serum thiamine level at day 6 postoperatively was below the lower limit of normal. As the mechanism of Wernicke encephalopathy, we thought that decreased ability to store thiamine due to liver cirrhosis led to depletion of thiamine faster than had been expected. In cancer patients, clinicians must always remain aware of the possibility of Wernicke encephalopathy, especially in patients with liver dysfunction, which decreases the ability to store thiamine in the liver. Early detection and intervention may alleviate the symptoms of delirium and prevent irreversible brain damage.

Small Bowel Bacterial Overgrowth Is a Potential Mechanism for Thiamine Deficiency Identified after Roux-En-Y Gastric Bypass Surgery

Purpose: Present evidence supports a saturable, carrier-mediated exchange mechanism for thiamine transport across jejunum. It is proposed that thiamine deficiency after gastric bypass surgery results from prolonged nausea and emesis. We observed that individuals after gastric bypass surgery developed thiamine deficiency and elevation of serum folate levels, a proposed marker for small bowel bacterial overgrowth. We hypothesized that small bowel bacterial overgrowth interferes with absorption of thiamine from the small intestine. Methods: We performed a retrospective review of consecutive patients who underwent Roux-en-Y gastric bypass surgery from 2002–2004 in our institution. To eliminate immediate, post-operative changes, we included patients who received evaluation at 3 months or longer after surgery. There were 75 patients with determination of serum thiamine and folate levels. This included 48 females and 27 males with an average age of 46 years (range 21 to 68). Five patients with low serum thiamine and elevated serum folate levels had undergone glucose-hydrogen breath testing. Results: There were 37 patients with serum folate levels greater than the upper limit of normal; among these patients, 23 (62%) had serum thiamine levels below the lower limit of normal. There were 38 patients with serum folate levels within normal range; 11 (29%) had serum thiamine levels below the lower limit of normal (Chi-squared test comparing thiamine deficiency in the normal folate group to the elevated folate group: p< .01). All 5 patients who underwent glucose-hydrogen breath testing had abnormal findings supporting a diagnosis of small bowel bacterial overgrowth: 4 patients had a significant rise (>10 ppm) in breath hydrogen within 45 minutes after glucose ingestion, while 1 had an elevated fasting breath hydrogen level of 57 ppm. Conclusions: Thiamine deficiency is common after Roux-en-Y gastric bypass surgery. Small bowel bacterial overgrowth appears to be common after gastric bypass surgery, as determined by elevation of serum folate levels or the presence of abnormal glucose-hydrogen breath testing. The results support the hypothesis that small bowel bacterial overgrowth following gastric bypass surgery can interfere with thiamine absorption.

Vermal atrophy of alcoholics correlate with serum thiamine levels but not with dentate iron concentrations as estimated by MRI

Chronic alcohol consumption is frequently accompanied by cerebellar degeneration. The exact aetiology of alcoholic cerebellar degeneration is still a matter of debate. The aim of the present study was to investigate whether patients with chronic alcohol consumption exhibit a decrease in dentate nuclei intensity as measured by MRI, and if so, whether this decrease correlates with cerebellar atrophy as revealed by MR imaging or with clinical signs of cerebellar ataxia. A decrease in dentate nuclei intensity would indirectly indicate that iron accumulation, and therefore, oxidative stress may play a role in alcoholic cerebellar degeneration. MRI of 45 alcoholics and 44 age and sex-matched healthy control subjects was performed using a 3D-T1-weighted fast low angle shot (FLASH) echo sequence. Signal intensities of the dentate nuclei and cerebellar white matter were bilaterally measured. Planimetric measurements of cerebellar size were performed using a 3D-T1-weighted magnetization prepared rapid acquisition gradient echo (MPRAGE) sequence. Results demonstrated that dentate nuclei intensity was not significantly decreased in patients with chronic alcohol consumption (mean +/- SD signal intensity 65.36 +/- 13.0) if compared with control subjects (mean +/- SD signal intensity 68.95 +/- 9.4) (p = 0.15). Dentate nuclei intensity did not correlate with cerebellar size neither in control subjects nor in alcoholics. In contrast, vitamin B1 level correlated with cerebellar size in alcoholics even if the vitamin B1 concentration was within normal values (r = 0.344, p = 0.028). These results support the view that thiamine deficiency rather than direct neurotoxic effects of alcohol is the main causative factor for the development of alcoholic cerebellar degeneration.

ビタミンＢ１欠乏がＪｕｍｂｌｉｎｇ現象の原因と考えられた症例

We report here a case of a 55-year-old man who showed the jumbling phenomenon due to thiamine deficiency.This patient complained of disturbances in visual fixation during walking after about 10 days fasting. His serum thiamine level was low but other serum vitamin levels were within the normal ranges. Neuro-otological examination showed bilateral canal paresis, saccadic pursuit and disturbance of the optokinetic responses. After prescribing thiamine, his clinical symptoms recovered gradually and caloric responses, eye tracking and optokinetic responses improved simultaneously. We consider that the jumbling phenomenon in this case was caused by not only a loss of bilateral vestibular function but also by brainstem dysfunction.

Nutrition following gastric operations for morbid obesity.

Nutritional status after 238 gastric operations designed to reduce caloric intake and body weight to within 30% of ideal was assessed by measuring body composition using the multiple isotope dilution technique. Body cell mass (BCM) and body fat were quantitated before and at 24 months after operation. Malnutrition was defined as a total exchangeable sodium (Nae) to total exchangeable potassium (Ke) ratio greater than 1.22. Data were collected on 96 patients. All had lost a mean of 26% of preoperative weight by 24 months. Significant malnutrition occurred in 47 patients whose Nae/Ke ratio ranged from 1.23 to 2.17 (1.45 +/- 0.03). There was a 34% reduction in body fat. The malnourished patients lost 10% more BCM by 24 months than did the normally nourished group. Malnutrition resolved as the stoma enlarged in 19 patients, and dietary counselling helped eight patients. Eighteen patients required reoperation to establish a larger orifice, and endoscopic dilatation was successful in two patients. Administration of a liquid diet via the gastrostomy was required for prolonged periods in some malnourished patients. Seventeen patients who had lost weight rapidly over a short time had low vitamin B12, thiamine, and serum and RBC folate levels. One patient had a markedly decreased serum thiamine level with neuropathy. Symptoms of weakness, easy fatigability, and lassitude were found in the malnourished patients. Low thiamine and serum folate levels were also seen in patients ingesting a liquid diet of 750 kcal with a standard multivitamin supplement. Malnutrition was not seen in these patients. In the 49 patients who remained well nourished, BCM decreased by 19%, but the Nae/Ke remained normal. Weight loss was well tolerated, and no patients required reoperation or supplemental liquid diet to increase caloric or protein intake. The degree of malnutrition in patients after gastric operations is as great as following intestinal bypass but is not associated with liver failure. Malnutrition with vitamin deficiency is a great potential hazard in patients who undergo intake-limiting operations, especially if the goal of the operation is to restore near-normal weight. Current operations are successfully designed to maintain a small orifice size, so that the risks of malnutrition are likely to increase in the future.