Thiamine, riboflavin, and pyridoxine deficiencies in a population of critically ill children (original) (raw)
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Wernicke's encephalopathy in a child with high dose thiamine therapy
Korean journal of pediatrics, 2014
Wernicke's encephalopathy is an acute neurological disorder characterized by mental confusion, oculomotor dysfunction, and ataxia. It has been reported in individuals with alcohol dependence, hyperemesis gravidarum, and prolonged parenteral nutrition without vitamin supplementation. Here we present the case of a 13-year-old male patient with neuroblastoma and a history of poor oral intake and nausea for 3 months. After admission, he showed gait disturbances, nystagmus, and excessive dizziness; his mental state, however, indicated he was alert, which did not fit the classical triad of Wernicke's encephalopathy. A diagnosis of Wernicke's encephalopathy was made only after brain magnetic resonance imaging and serum thiamine level analyses were performed. The patient's symptoms remained after 5 days of treatment with 100-mg thiamine once daily; thus, we increased the dosage to 500 mg 3 times daily, 1,500 mg per day. His symptoms then improved after 20 days of replacement...
Haemorrhagic thiamine deficient encephalopathy following prolonged parenteral nutrition
Journal of Neurology, Neurosurgery & Psychiatry, 1992
Neuropathological examination of three patients who were maintained on parenteral nutrition without substitution of thiamine demonstrated an acute haemorrhagic encephalopathy. The lesions differed substantially from the classic features of thiamine deficient encephalopathy regarding the histopathological alterations and the topographical distribution. The extreme rapidity of thiamine deprivation may have been responsible for the abrupt clinical onset of the disease and the intensity of the morphological alterations.
Vitamin B1 in critically ill patients: needs and challenges
Background: Thiamine has a crucial role in energy production , and consequently thiamine deficiency (TD) has been associated with cardiac failure, neurological disorders, oxidative stress (lactic acidosis and sepsis) and refeeding syndrome (RFS). This review aims to explore analytical methodologies of thiamine compound quantification and highlight similarities, variances and limitations of current techniques and how they may be relevant to patients. Content: An electronic search of Medline, PubMed and Embase databases for original articles published in peer-reviewed journals was conducted. MethodsNow was used to search for published analytical methods of thiamine compounds. Keywords for all databases included " thiamine and its phosphate esters " , " thiamine methodology " and terms related to critical illness. Enquiries were also made to six external quality assurance (EQA) programme organisations for the inclusion of thiamine measurement.
PARENTERAL THIAMINE AND WERNICKE'S ENCEPHALOPATHY: THE BALANCE OF RISKS AND PERCEPTION OF CONCERN
Alcohol and Alcoholism, 1997
Wernicke's encephalopathy, a disorder with significant mortality and high morbidity, is common amongst alcohol-dependent patients. Thiamine deficiency appears to play a key role in its aetiology, and parenteral high-dose thiamine is effective in prophylaxis and treatment. Unfortunately, reports of rare anaphylactoid reactions have led to a dramatic reduction in the use of parenteral thiamine, and it is possible that this change in treatment has led, or will lead, to an increase in morbidity and mortality. There is a need for education of doctors who treat alcohol-dependent patients, in order to ensure appropriate use of parenteral thiamine in prophylaxis and treatment of this disorder.
SN Comprehensive Clinical Medicine
Thiamine deficiency is associated with life-threatening pathologies, as Wernicke syndrome (WS), Korsakoff syndrome (KS), Marchiafava-Bignami (MB) disease, and wet or dry beri-beri (BB). Among the etiological factors, the thiamine deficiency may be suspected in subjects at risk for malnutrition (decreased nutrient intake, increased nutrient losses, or impaired nutrient absorption). Computed tomography (CT) but especially magnetic resonance imaging (MRI) is the best method to detect diencephalic and mesencephalic cytotoxic edematous lesions in patients with acute WS, with hyperintense on long-TR spin-echo MRI imaging and low-density signal abnormalities on CT scans. We report a case of WS in an 82-year-old woman with the history of cancer and eating disorder, who presented a neurological worsening during recovery, associated with low serum thiamine levels and the presence of symmetrical areas of hyperintense signal in the long-TR sequences of MRI. After parenteral thiamine supplementa...
International Journal Of Community Medicine And Public Health, 2022
Background: Aim of the study was to study the effect of vitamin B12 supplementation in children with severe acute malnutrition (SAM).Methods: A total of 100 children were enrolled in the study in two different time frames. Group A consisted of 50 children with SAM enrolled from November 2016 to May 2017 and managed as per existing national protocol for facility-based SAM management while group B consisted of 50 children enrolled from June 2017 to Dec 2017 who were tested for vitamin B12 deficiency on admission and supplemented with vitamin B12 in presence of vitamin B12 deficiency hematological and anthropometric parameters of both groups were compared at 12 weeks of rehabilitation. Results: At 12±1 weeks, 38% children from group A and 24% from group B were still anemic (p=0.13). No one from either group had folic acid deficiency while deficiency of vitamin B12 was present in 14% and 6% cases in group A and group B respectively (p>0.05). Mean weight gain at 12±1 weeks, in group...
Vitamins are Indeed Vital Amines: A Discussion of 3 Deficiencies With Neurologic Manifestations
Child Neurology Open, 2021
Optimal functioning of the human nervous system depends on a constant supply of nutrients, vitamins, and minerals. In the developed world, nutritional deficiencies are relatively rare and infrequently present with neurologic manifestations. These neurologic disorders can be mistaken for inflammatory and/or autoimmune phenomena. This manuscript describes 2 pediatric cases with neurologic signs/symptoms arising from vitamin deficiencies—(1) optic neuropathy and (2) Wernicke encephalopathy associated with a Guillain-Barre-like pattern of weakness. The 2 cases and the subsequent discussion of vitamin A, B1, and B12 deficiencies underscore the value of taking a thorough dietary history and emphasize risk factors for these 3 nutritional deficiencies.