Altered Mental Status: Thiamine may cause few side effects if given as an i/v push

Clinical bottom line (level 4)

  1. In patients who were at risk of thiamine deficiency and received thiamine by i/v push, very few had significant side effects (e.g. generalised transient burning (NNF = 1111 for 2 hours) )
Wrenn et al: Ann Emerg Med 1989; 18: 867-870
Expires January 2004

The study

Case series with unblinded, unobjective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: American emergency dept

989 patients (aged range 16 - 80 years, 80% male) "at risk for thiamine deficiency"[1] AND needing iv fluids

Excluded if
  • history of previous adverse reaction to thiamine


Cases: 989 patients (80% male, mean age ): patients who received thiamine
Controls: ?patients : none


Outcomes studied:

transient generalised pruritis

transient burning sensation


The evidence

risk factor transient generalised pruritis
present		 transient generalised pruritis
absent		 unadjusted OR
(% CI)		 NNH
(95% CI)
administration of i/v thiamine 1 988 1111
(333 to infinite)
no administration of i/v thiamine 988 988

Patient expected event rate for transient burning sensation: 1.1%
risk factor transient burning sensation
present		 transient burning sensation
absent		 unadjusted OR
(% CI)		 NNH
(95% CI)
administration of i/v thiamine 11 978 90
(56 to 200)
no administration of i/v thiamine 0 0

  • patients observed closely for 2 hours, then until discharge (<12h)

    Comments

    1. "at risk for thiamine deficiency" - they suggest e.g. patients with alcohol abuse, altered mental status, hypoglycaemia (fingerstick), hypothermia, malnourished appearance, or AIDS. Within the study 80% related to alcohol, 1% hypoglycaemia...
    2. all patients received only short term follow-up

    Citation

    1. Wrenn KD, Murphy F, Slovis CM: A toxicity study of parenteral thiamine hydrochloride.. Ann Emerg Med 1989; 18: 867-870
    Contributor: Matt Taylor and Bob Phillips, October 1999
    Reviewer: Edward Etchells

    Clinical Question.
    Patient clinical indication for thiamine
    Intervention or Exposure administration of iv thiamine
    Outcome dangerous adverse effects