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Oral or intravenous thiamine in the emergency department
  1. Rupert Jackson, Consultant,
  2. Stewart Teece, Clinical Research Fellow
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether parenteral thiamine was more effective than an oral preparation at replacing thiamine in alcoholics without encephalopathy. Twenty five papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Rupert Jackson,ConsultantChecked by Stewart Teece, Clinical Research Fellow

    Clinical scenario

    A 56 year old man attends the emergency department with cellulitis in his left leg. He is unkempt and drinks heavily. The cellulitis can be treated as an outpatient with oral antibiotics, but you suspect he is thiamine deficient as a result of long term alcohol misuse. You are therefore about to prescibe an intravenous infusion of thiamine as you have always given it this way. This will commit you to an inpatient admission and beds are at a premium.You wonder whether there is any basis for your prescribing practice—perhaps oral thiamine would be just as effective.

    Three part question

    In [thiamine deficient patients without Wernickes encephalopathy] is [parenteral delivery of thiamine better than the oral route] at [achieving bioavailability without side effects]?

    Search strategy

    Medline 1966-03/04 using the OVID interface. [(exp thiamine OR thiamine.af OR (vitamin adj5 b1).af) AND (exp infusions, intravenous/OR exp injections, intravenous OR intravenous.af OR exp infusions, parenteral OR parenteral.af) AND (exp administration, oral OR oral.af OR exp tablets OR tablet.af OR po.af)] LIMIT to human AND English Language.

    Search outcome

    Altogether 25 papers were found of which two were relevant to the three part question (table 4).

    Table 4

    Comment(s)

    Clearly concordance with treatment also has to be considered. This has not been considered at all in the papers found.

    CLINICAL BOTTOM LINE

    Oral thiamine administration is as effective as parenteral administration after five days. In compliant alcoholics without encephalopathy oral administration is the route of choice.

    Report by Rupert Jackson,ConsultantChecked by Stewart Teece, Clinical Research Fellow

    References

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