Why thiamine before dextrose

Twitter Facebook. This Issue. Citations View Metrics. February 25, Jason B. Hack, MD 1 ; Robert S. Hoffman, MD 1. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. On Twitter, he is precordialthump. This site uses Akismet to reduce spam. Learn how your comment data is processed. Traditional teaching is to never treat hypoglycaemia prior to giving thiamine due to risk of precipitating Wernicke encephalopathy — this is a myth — never delay treatment of hypoglycemia The concern is that an excessive carbohydrate load will lead to the build up of toxic metabolites when the activity of these enzymes is reduced because of thiamine deficiency There are no reported instances of a single bolus of glucose precipitating Wernicke encephalopathy Prolonged carbohydrate administration e.

Critical Care Compendium. Chris Nickson. His one great achievement is being the father of two amazing children. Leave a Reply Cancel reply. Based on our findings, a delay in giving glucose to hypoglycemic patients cannot be recommended at this time, although prompt thiamine supplementation after or concurrent with a return to normoglycemia is recommended. Abstract Background: The prevailing teaching in medical school curricula and in medical textbooks is that if thiamine deficiency is suspected, thiamine supplementation should be given before administering glucose.

Please enter text to search. Search by Outlines. Set Search Limits. Why Alcoholics Should Receive Vitamin B1 Thiamine by IV Before any Glucose Infusions Summary : It is well known that chronic alcoholics are at high risk for being deficient in vitamin B1 thiamine , which is known to put the patient at an increased risk for Wernicke-Korsakoff Syndrome, cerebellar degeneration, and cardiovascular dysfunction. The inability of pyruvate to enter the TCA cycle causes the cell to convert the pyruvate to lactate or lactic acid in order to be able to maintain glycolysis at a minimum rate.

Therefore, if you feed the cell more glucose without giving the needed thiamine to allow for the forward movement of cellular reactions for complete ATP generation, you only increase the amount of lactic acid produced.

Editor-in-Chief: Anthony J. Effect of chronic ethanol administration on thiamin transport in microvillous vesicles of rat small intestine. Alcohol ; Hoyumpa AM, Jr. Mechanisms of thiamin deficiency in chronic alcoholism.

Am J Clin Nutr ; Lieberman M, Marks AD. Chapter Tricarboxylic acid. Lieberman M, Marks AD eds.