Thiamine Deficiency In Patients Research Articles

Cross-Sectional Study of Thiamine Deficiency and Its Associated Risks in Emergency Care.

Growing data indicates that thiamine deficiency occurs during acute illness in the absence of alcohol use disorder. Our primary objective was to measure clinical factors associated with thiamine deficiency in patients with sepsis, diabetic ketoacidosis, and oncologic emergencies. This was an analysis of pooled data from cross-sectional studies that enrolled adult emergency department (ED) patients at a single academic center with suspected sepsis, diabetic ketoacidosis, and oncologic emergencies. We excluded patients who had known alcohol use disorder or who had received ED thiamine treatment prior to enrollment. Investigators collected whole blood thiamine levels in addition to demographics, clinical characteristics, and available biomarkers. We defined thiamine deficiency as a whole blood thiamine level below the normal reference range and modeled the adjusted association between this outcome and age. There were 269 patients, of whom the average age was 57years; 46% were female, and 80% were Black. Fifty-five (20.5%) patients had thiamine deficiency. In univariate analysis, age >60years (odds ratio [OR] 2.5, 95% confidence interval [CI], 1.3-4.5), female gender (OR 1.9, 95% CI 1.0-3.4), leukopenia (OR 4.9, 95% CI 2.3-10.3), moderate anemia (OR 2.8, 95% CI 1.5-5.3), and hypoalbuminemia (OR 2.2, 95% CI 1.2-4.1) were associated with thiamine deficiency. In adjusted analysis, thiamine deficiency was significantly higher in females (OR 2.1, 95% CI 1.1-4.1), patients >60years (OR 2.0, 95% CI 1.0-3.8), and patients with leukopenia (OR 5.1, 95% CI 2.3-11.3). In this analysis, thiamine deficiency was common and was associated with advanced age, female gender, and leukopenia.

Predicting Recurrent Deficiency and Suboptimal Monitoring of Thiamin Deficiency in Patients with Metabolic and Bariatric Surgery.

Vitamin B1 (thiamine) deficiency (TD) after metabolic and bariatric surgery (MBS) is often insidious and, if unrecognized, can lead to irreversible damage or death. As TD symptoms are vague and overlap with other disorders, we aim to identify predictors of recurrent TD and failure to collect B1 labs. We analyzed a large sample of data from patients with MBS (n = 878) to identify potential predictors of TD risk. We modeled recurrent TD and failure to collect B1 labs using classical statistical and machine learning (ML) techniques. We identified clusters of labs associated with increased risk of recurrent TD: micronutrient deficiencies, abnormal blood indices, malnutrition, and fluctuating electrolyte levels (aIRR range: 1.62-4.68). Additionally, demographic variables associated with lower socioeconomic status were predictive of recurrent TD. ML models predicting characteristics associated with failure to collect B1 labs achieved 75-81% accuracy, indicating that clinicians may fail to match symptoms with the underlying condition. Our analysis suggests that both clinical and social factors can increase the risk of life-threatening TD episodes in some MBS patients. Identifying these indicators can help with diagnosis and treatment.

Pre- and Post-surgical Prevalence of Thiamine Deficiency in Patients Undergoing Bariatric Surgery: a Systematic Review and Meta-analysis.

Thiamine deficiency is a life-threatening nutritional abnormality observed in the patients with obesity and following bariatric surgery. The aim of the present study is to determine the prevalence of thiamine deficiency prior to and after bariatric procedures. PubMed, Web of Science, Google scholar, CENTRAL, ProQuest, and Scopus were searched to retrieve relevant studies containing data on thiamine deficiency in patients with obesity who underwent bariatric surgery. A proportional meta-analysis approach was used to pool the prevalence of thiamine deficiency prior and after surgery. Our comprehensive literature search retrieved 41 studies with relevant data. The pooled prevalence of thiamine deficiency was 7% (95% CI: 4-12%) at baseline. We observed that 19% (95% CI: 0-68%), 9% (95% CI: 3-17%), and 6% (95% CI: 3-9%) of patients had developed thiamine deficiency at 3 months, 6 months, and 1 year after surgery, respectively. We also report that the prevalence of thiamine deficiency in pregnant women who had history of bariatric surgery. The rate was highest in the first trimester (12%) compared to that in the second (8%) and third (10%) trimesters. The baseline prevalence is 7% for thiamine deficiency in bariatric surgery candidates. The prevalence rate of thiamin deficiency increased to 19% and 9% 3 and 6 months after surgery; however, the rate decreased to 6% 1 year after surgery. Due to the higher prevalence of thiamine deficiency in the early post-operative phase, close monitoring during this period is recommended. A similar strategy should be implemented for pregnant women with history of bariatric surgery in their first trimester.

Thiamine deficiency after sleeve gastrectomy

The prevalence of morbid obesity has risen to global epidemic proportions. Bariatric surgery has been proven to be a safe and effective treatment for obesity with weight reduction, resolution of obesity-related co-morbidities, improved quality of life and an increased life expectancy. Sleeve gastrectomy (SG) is the most commonly performed bariatric procedure worldwide. Obesity is associated with micronutrient deficiencies that results in the high prevalence of deficient vitamins status prior to bariatric surgery. After bariatric surgery, these micronutrient and vitamins deficiencies increase or occur de novo, and they may be threatening when left unattended. This presented clinical case demonstrates the clinical features of thiamine deficiency as well as the principles of laboratory and instrumental diagnostics. Electromyo­graphy is an informative method for diagnostic of muscle weakness. The lower serum thiamine level, neurological symptoms and electromyography results are the most important for the diagnosis of thiamine deficiency. Pathogenetic treatment can improve the patient’s condition in a short period of time. Although the SG is a purely restrictive procedure with no malabsorptive component, microelement or vitamin deficiency can occur in patients after procedure. The presented clinical case demonstrates the importance of timely thorough diagnosis and correct treatment of thiamine deficiency in patients after SG. Thus, patients after the LRS in deficiency of vitamin B1 may cause the development of neurological comp­lica­tions of varying severity, in particular dysmetabolic polyneuropathy. This condition is reversed and administration of an adequate and timely substitution therapy in patients with thiamine insufficiency allows be avoided the development of fatal complications.

Bowel Cleansing Protocol in Colonoscopy: Does It Affect Blood Thiamine Level?

Background: The burden of vitamin B1 or thiamine deficiency in patients undergoing digestive surgery is quite enormous. In the field of gastroenterology, pre-colonoscopy preparation might affect thiamine level. However the burden is not well defined. This study was conducted to confirm whether there is significant decrease of blood thiamine level in post-colonoscopy compared to pre-colonoscopy group.Method: This cross-sectional study was carried out at gastrointestinal endoscopy center of Cipto Mangunkusumo National General Hospital, Jakarta from October 2018 to January 2019. The inclusion criteria were patients equal or more than 18-year-old who underwent colonoscopy. The exclusion criteria were malnutrition, history of post-gastrointestinal resection, definitive diagnosis of cancer, and chronic alcoholism.Results: The median value of blood thiamine level is 58 (20-78) for pre-colonoscopy group and 58 (25-79) for post colonoscopy group (p=0.31).Conclusion: There was no significant decrease of blood vitamin B1 level in post-colonoscopy compared to pre-colonoscopy group.

PT08.3: The Evaluation of Thiamine Deficiency in Patients with Hypervolemia Under the Furosemide Treatment

PT08.3: The Evaluation of Thiamine Deficiency in Patients with Hypervolemia Under the Furosemide Treatment

Thiamine Deficiency in People with Obesity (P18-060-19)

ObjectivesThiamine (vitamin B1) and other micronutrient deficiencies are commonly observed after bariatric surgery. However, there is evidence that patients with obesity may be deficient in thiamine even before surgery, possibly due to metabolic changes following recent weight loss or decreased intake through dietary restriction. Type II diabetes may also adversely affect thiamine absorption and increase urinary thiamine losses, placing patients with this condition at increased risk of deficiency. The purpose of this research is to (1) determine the prevalence of thiamine deficiency in patients at a bariatric surgery clinic and compare this across type II diabetes status, race, and gender; and (2) determine the relationship between recent weight loss and thiamine deficiency. MethodsThis is a retrospective observational study of patients with obesity who were evaluated at the preoperative bariatric surgery clinic at the Washington, DC VA Medical Center between January 1, 2012 and April 1, 2018. Patients who had prior bariatric surgery, current or recent history of alcohol abuse, current use of diuretics or vitamin supplements, or for whom no thiamine test was ordered were excluded. All patients had a BMI of 31.7–49.0 kg/m2. Thiamine deficiency was defined as a test value below the reference range. Weight data were collected at the initial evaluation and up to four months prior. ResultsOf 155 clinic patients, 107 met all inclusion criteria. Thiamine deficiency was found in 36 (33.6%) patients. Chi-square tests did not show any differences in prevalence between patients with type II diabetes and those without, or by gender or race. Preliminary logistic regression analyses indicated that the odds of thiamine deficiency were 14% higher per % increase in recent weight loss (OR = 1.14, 95% CI: 1.01–1.29). ConclusionsApproximately one third of those evaluated at the bariatric surgery clinic were found to have a test result indicating thiamine deficiency. This suggests that people with obesity, especially those engaging in weight loss efforts, may benefit from additional nutritional screening. Funding SourcesNone.

A Prospective Evaluation of Vitamin B1 (thiamine) Level in Myeloproliferative Neoplasms: Clinical Correlations and Impact of JAK2 Inhibitor Therapy

Background:Vitamin B1 (Thiamine) deficiency might result in Wernicke's encephalopathy (WE); the latter was reported in clinical studies with the JAK2 inhibitor fedratinib resulting in disruption of clinical development, despite efficacy in patients with myelofibrosis (MF) (JAMA Oncol, 2015, 5). Our objectives were i) to determine the incidence of thiamine deficiency in patients with myeloproliferative neoplasms (MPN), ii) assess clinical correlations of thiamine level and iii) determine the impact of JAK2 inhibitor therapy on thiamine level in MPN.Methods:After Institutional review board approval, patients referred with a suspected diagnosis of MPN were enrolled. All clinical and laboratory variables including treatment details were collected at the time of referral. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis of thiamine diphosphate in whole blood was performed at the time of referral. Reference range for thiamine level in whole blood was 70-180 nmol/L. The JMP® Pro 13.0.0 software from SAS Institute, Cary, NC, USA, was used for all statistical analysis.Results:A total of 115 patients were prospectively enrolled and included 28 patients without MPN and 87 with MPN. 87 MPN patients (median age, 65 years, 52% males) included 32 with primary myelofibrosis (PMF), 17 with polycythemia vera (PV), 17 with essential thrombocythemia (ET), 11 with post PV MF, 8 with post ET MF, and 2 with MPN-U. The MPN and non-MPN patients were similar in their gender distribution, pattern of alcohol use, malnutrition and multivitamin use (p=0.24, 0.12, 0.54 and 0.78 respectively), although the former were older (p=0.09).Median thiamine level of the study patients was 167 nmol/L (range; 60-442 nmol/L) with only two (1.7%) female patients displaying level below the normal reference range. One belonged to the non-MPN group (thiamine level 68 nmol/l); a 26 year old female with erythroid leukemia in the absence of alcohol use or malnutrition; the second patient (thiamine level 60 nmol/l) was a 38 year old female with ET, CALR type 2 mutated on hydroxyurea, without a history of alcohol use or malnutrition. Overall, both MPN and non-MPN patients displayed similar thiamine level (p=0.89).Clinical correlations of thiamine level in MPNMedian thiamine level was similar amongst post ET MF, ET, PMF, PV, and post PV PMF patients (127, 162, 166, 190 and 209 nmol/L respectively, p=0.13). No significant effect on thiamine level was apparent for age, gender, hemoglobin, platelet count, dynamic international prognostic scoring system (DIPSS) score, unfavorable cytogenetics, palpable splenomegaly, or constitutional symptoms. Interestingly, thiamine level was significantly higher in JAK2 mutated cases (median 177 nmol/L vs 145 nmol/L in unmutated cases, p=0.03). Furthermore, when analysis was restricted to PMF patients, thiamine level positively correlated with JAK2V617F mutant allele burden (p=0.01) and leukocyte count > 10 x 109/L (p=0.03). JAK2 mutated PMF patients with leukocyte count > 10 x 109/L depicted significantly higher thiamine levels (median 313 nmol/L) compared to JAK2 mutated patients without leukocytosis (median 164 nmol/L) and JAK2 unmutated patients with or without leukocytosis (median 192 nmol/L and 143 nmol/L respectively)(p=0.004, Figure 1a).Impact of treatment on thiamine levelTreatment with hydroxyurea was documented in 35 patients with no significant impact on thiamine level (p=0.28). 27 patients were on JAK inhibitors (median duration at referral; 41 months); 12 patients on ruxolitinib and 15 MF patients on momelotinib as part of a clinical trial. Thiamine level was similar amongst JAK inhibitor treated vs untreated patients (median 166 vs 169.5 nmol/L respectively, p=0.72). Annual thiamine measurements were performed on 15 patients treated with momelotinib (median duration 52 months, range 18-60 months). Despite fluctuations in thiamine levels, only two patients were noted to have thiamine level below normal (65 and 69 nmol/L at year 3), which subsequently improved to 101 and 121 nmol/L by year 4, while still on treatment (Figure 1b).Conclusions:The current study confirms the rarity of subnormal thiamine levels in MPN and the limited impact of treatment on thiamine levels, including with JAK2 inhibitors. Our novel observation regarding the correlation of thiamine level with JAK2V617F mutant allele burden and leukocyte count requires further exploration. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Missing the early signs of thiamine deficiency. A case associated with a liquid-only diet

BackgroundWernicke encephalopathy (WE) predominantly occurs in alcoholic patients. Few case reports have described this diagnosis as a result of dieting. The diagnosis is often missed or delayed resulting in permanent and severe neurologic sequelae and even death. The typical neurological signs may be absent or missed during the early stages of thiamine deficiency.Case reportA 23-year-old female presented to the hospital with confusion, bilateral lateral rectus palsy, and ataxia. Based on the typical neurological triad, WE was suspected. The brain MRI was also typical for WE. Prompt clinical improvement was seen within days after intravenous thiamine supplementation. A detailed medical history revealed that during the past 3 months she had been following a liquid-only diet and had lost about 30 kg. During that time, she had visited the emergency department on multiple occasions due to fatigue, nausea, and vomiting.ConclusionA high level of suspicion is required by physicians to recognize that fatigue, nausea, and vomiting may represent early signs of thiamine deficiency in patients at risk for nutritional deficiencies. Empirical thiamine supplementation may be reasonable in such cases.

Prevalence of thiamine deficiency in a stable heart failure outpatient cohort on standard loop diuretic therapy

The prevalence of thiamine deficiency in heart failure (HF) patients has been reported to be as high as 50% in outpatient settings and has been found to be as high as 96% in the inpatient setting. Results from previous studies, however, have been inconsistent and further investigation is needed to clarify the true prevalence of thiamine deficiency in patients with chronic HF. The aim of this study was to determine the prevalence of thiamine deficiency in a random sample of stable HF outpatients receiving standard of care loop diuretic therapy. A cross-sectional study was conducted in 30 HF patients scheduled for regular follow-up visits in the Mayo Heart Failure Clinic. Whole-blood thiamine diphosphate was measured using high-performance liquid chromatography. Additional clinical and demographic features were collected through review of electronic medical records. The estimated prevalence of thiamine deficiency in stable HF patients was calculated to be <11.6%. There was no correlation between diuretic dose and thiamine levels (r=0.02, P=0.93) and there was no correlation found between left-ventricular ejection fraction (LVEF) and thiamine levels (r=0.147, p=0.44). Our findings suggest that the prevalence of thiamine deficiency, based on standard normal values, in a stable outpatient HF cohort on standard loop diuretic therapy is very low. Previous work has demonstrated improvements in myocardial function with high-dose thiamine supplementation regardless of thiamine blood levels, however, suggesting that thiamine may become conditionally essential with HF. Therefore, we suggest that a disease-specific reference range be determined to accurately identify HF patients that would benefit from thiamine supplementation.

Essential nutrient requirements of the elderly

Essential nutrient requirements of the elderly Robert Skully Department of Family Medicine, Grant Medical Center, OhioHealth, Columbus, OH, USA Abstract: Government-sponsored medical organizations in developed countries have established guidelines for daily nutritional requirements. For most nutrients there is general agreement surrounding these requirements, which are based on exhaustive scientific literature review. Differences in these recommendations exist because of genetic and environmental factors that result in differences in disease susceptibility, but also due to incomplete understanding of the roles of nutrients in disease prevention. This review briefly summarizes nutrient recommendations for older adults such as where those recommendations differ from those of younger adults; and includes areas of developing understanding such as the possible role of thiamine deficiency in patients with congestive heart failure, the need for some older adults to ingest absorbable forms of vitamin B12, the high prevalence of vitamin D deficiency, the potential role of vitamin K in bone health, the need for higher levels of protein intake in order to stimulate muscle protein synthesis as one ages, the role of calcium in osteoporosis, and the possible need for zinc supplementation in hospitalized patients. Keywords: vitamins, nutritional requirements, energy expenditure, energy consumption

Constipation in Patients with Thiamine Deficiency after Roux-en-Y Gastric Bypass Surgery

Background/Aims: Roux-en-Y gastric bypass surgery is the most common bariatric surgery worldwide. We have described thiamine deficiency in patients with small intestinal bacterial overgrowth after gastric bypass. We hypothesized that symptoms of thiamine deficiency are common after gastric bypass. The aims of this study were to examine the prevalence of and treatment of symptoms of thiamine deficiency after gastric bypass. Methods: This is a prospective study performed in a large urban, community hospital. Consecutive gastric bypass patients seen from February 1, 2008 to May 1, 2009 are included. Thiamine deficiency in this study included both: consistent clinical symptoms and either (1) low blood thiamine level or (2) resolution of clinical symptoms after receiving thiamine. Results: Of 151 patients, 25 females and 2 males met the criteria for thiamine deficiency (prevalence of 18%). In these 27 patients, 12 had one symptom of thiamine deficiency, while 15 had symptoms consistent with multiple subtypes. Eleven patients reported constipation at 0.33-12 years (mean 4.8) after gastric bypass. Elevated serum folate levels were seen in 6 of 10 tested patients and there was an abnormal glucose-hydrogen breath test in 9 of 10 tested patients, supporting the presence of small intestinal bacterial overgrowth. Frequency of defecation improved after thiamine treatment. Conclusion: Thiamine deficiency resulting from small intestinal bacterial overgrowth should be considered in patients being seen for constipation after gastric bypass surgery.

Thiamine Supplementation for the Treatment of Heart Failure: A Review of the Literature

A systematic review of the literature was performed by searching Pubmed and EMBASE databases using the terms "thiamine," "vitamin B1," "heart failure," "systolic dysfunction," "ventricular dysfunction," "cardiomyopathy," "ventricular failure," and "systolic failure." Relevant trials and articles were evaluated pertaining to thiamine deficiency in patients with heart failure (HF) and references were searched for further inclusion of articles. A total of 20 articles were reviewed and summarized in detail. While more research is needed to fully elucidate the clinical thiamine deficiency in HF patients, recent evidence has indicated that supplementing with thiamine in HF patients has the potential to improve left ventricular ejection fraction. Thiamine deficiency appears to be not uncommon in patients with HF, and supplementation with thiamine has been shown to improve cardiac function, urine output, weight loss, and signs and symptoms of HF. Therefore, this simple therapy should be tested in large-scale randomized clinical trial to further determine the effects of thiamine in HF patients.

A Novel Scoring System to Guide Risk Assessment of Wernicke's Encephalopathy

Thiamine deficiency in patients who abuse alcohol can cause Wernicke's encephalopathy (WE). Thiamine supplements are given to prevent this complication. Guidelines exist for giving thiamine supplementation in the inpatient population. However, similar guidelines are not available for clinicians detoxifying patients in the community, and consequently, assessment of risk of WE and prophylaxis can be inconsistent. A scoring system to assess risk of WE was developed and evaluated by comparing practice before and after introduction of the system. One hundred and twenty-six cases requiring alcohol detoxification were examined: 94 before introduction of the scoring system and 32 afterward. Before introduction of the scoring system, a risk assessment for developing WE was performed in 30% of patients and parenteral thiamine prescribed in 32%. After introduction of the scoring system, risk assessment and administration of parenteral thiamine increased to 100 and 75%, respectively. There was 1 probable case of WE before introduction of the scoring system and none afterward. We conclude that assessment of WE is often inadequate, leading to inadequate thiamine administration. The new scoring system allows simple, structured risk assessment for WE and thus guides appropriate thiamine administration. This is of most value to clinicians treating the consequences of alcohol dependence in the community.

The Role of B Vitamins in the Management of Heart Failure

Heart failure (HF) is the leading cause of morbidity and mortality in industrialized countries, creating a significant burden on both the healthcare system and quality of life. Research efforts continue to explore new pharmaceutical or surgically based approaches to HF management, but the role of nutrition as an adjunct therapy has been largely ignored. Elderly age, anorexia, malabsorption, premature satiety, and disease severity are among the factors identified as contributing to reduced nutrient intakes in patients with HF. These factors suggest that patients with HF are at increased risk of multiple-nutrient deficiencies, including B vitamins. B vitamins may be of particular therapeutic interest because of their key roles as cofactors in energy-producing pathways. Recently, impaired stores of high-energy compounds have been linked with myocardial dysfunction and prognosis in patients with HF. Therefore, deficiencies of B vitamins might contribute to reduced energy stores and disease progression. This review summarizes the existing literature both with respect to the prevalence of B vitamin deficiency as well as evidence from supplementation trials in patients with HF. The findings suggest that most of the literature in this area has focused on thiamin deficiency in patients with HF, whereas other B vitamins remain largely unstudied. Although few sporadic trials suggest a role for B vitamins in the management of HF, none are conclusive. Therefore, there is a need for larger, more robust trials to assist in defining the B vitamin requirements as well as the impact of supplementation on both morbidity and mortality in patients with HF.

Thiamine deficiency and the etiology of tropical ataxic neuropathy

Tropical ataxic neuropathy (TAN) is a syndrome characterized by sensory polyneuropathy, sensory ataxia, bilateral optic atrophy and bilateral sensorineural deafness. The syndrome has occurred in endemic form in several African countries, and in epidemic form in Cuba. In endemic communities, the syndrome has a high prevalence and a demonstrated risk for high mortality. Despite several studies aimed at elucidating the etiological mechanisms of TAN, the etiology has remained unknown more than five decades after its original description. Chronic cyanide intoxication from a monotonous diet of cassava was long thought to be the major etiological factor, but there has been no evidence of a causal association. Vitamin deficiencies were thought to play little or no role in the pathogenesis of TAN. Evidence from the literature implicating chronic thiamine deficiency in the etiology of TAN is presented in this communication. This includes evidence of abnormal pyruvate metabolism reversed by thiamine in patients with TAN, evidence from erythrocyte transketolase activity indicating significant thiamine deficiency in patients with TAN compared to controls, and a placebo-controlled trial of therapeutic doses of thiamine which showed a clinically dramatic and statistically significant improvement in ataxia. A long-term thiamine supplementation program for susceptible individuals in endemic areas may be effective in the control and eventual eradication of the disease.

Thiamin deficiency and uncomplicated falciparum malaria in Laos.

Thiamin deficiency complicates severe Plasmodium falciparum malaria in Thailand and may contribute to acidosis. We therefore estimated the frequency of biochemical thiamin deficiency in patients presenting with uncomplicated falciparum malaria in southern Laos. Red cell transketolase activation coefficients (alpha) were measured in 310 patients presenting with uncomplicated falciparum malaria and 42 days after starting treatment. Twelve per cent of patients had biochemical evidence of severe deficiency (alpha values >1.31) at presentation, declining to 3% 42 days later. Thiamin deficiency was common in Lao patients admitted with uncomplicated P. falciparum infection and was reduced following treatment of malaria and multivitamin supplementation. The role of this preventable and treatable disorder in malaria and other acute infections, and the incidence of beriberi in rural Laos, needs further investigation.

Evaluating thiamine deficiency in patients with diabetes

Evaluating thiamine deficiency in patients with diabetes

Antibiotic Therapy Reverses Thiamine Deficiency in Patients Following Roux-en-Y Gastric Bypass Surgery

Purpose: As standard-of-care, all patients receive daily vitamin/mineral supplements following gastric bypass surgery. Present dogma states that thiamine deficiency after gastric bypass surgery is caused by prolonged nausea and emesis. We previously reported that a majority of patients following Roux-en-Y gastric bypass surgery have thiamine deficiency and it is associated with high serum folate levels and abnormal glucose-hydrogen breath tests. We hypothesize that small bowel bacterial overgrowth is a mechanism for thiamine deficiency following gastric bypass surgery. Methods: This is a retrospective chart review of patients who had Roux-en-Y gastric bypass surgery in 1999–2005. This study included: 1) post-operative patients who had whole blood thiamine levels below the lower limit of normal; 2) who then underwent a glucose-hydrogen breath test. Patients' sex, age, blood thiamine levels after oral thiamine supplementation, and blood thiamine levels after antibiotic therapy were recorded. Abnormal glucose-hydrogen breath test was defined by increased breath hydrogen of >20 ppm within 45 minutes after 50 grams oral glucose. This study involved 17 females and 4 males; age range was 22–64 years (Mean age: 52 years). Results: 21 patients (100%) with low blood thiamine had an abnormal glucose-hydrogen breath test. Of these patients, 15 received oral thiamine (100 mg twice daily); repeat thiamine levels remained low in all 15 (100%). Of these patients, 8 then received oral metronidazole while 1 received oral amoxicillin in addition to thiamine (100 mg twice daily); repeat blood thiamine levels were normal in all 9 (100%). While taking daily oral thiamine supplements, 2 patients who stopped taking metronidazole on a cycle of 7–10 days monthly had repeat thiamine levels drawn that were again low. Conclusions: After gastric bypass surgery, patients with thiamine deficiency have evidence for small bowel bacterial overgrowth. Daily oral thiamine supplements do not appear effective for treating thiamine deficiency. Antibiotic therapy combined with oral thiamine supplements was effective for treating thiamine deficiency. This study supports our hypothesis that small bowel bacterial overgrowth interferes with thiamine absorption from small intestine. Overgrowth may result from an absence of gastric acid secretion.

Thiamine deficiency in patients with B-chronic lymphocytic leukaemia: a pilot study

Malignancy associated primary thiamine deficiency has been documented in several experimental tumours, sporadic clinical case reports, and in a number of patients with fast growing haematological malignancies.Thiamine status was assessed...