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Constipation
Published in Charles Theisler, Adjuvant Medical Care, 2023
Thiamine: For obstinate constipation, thiamine has been used, even without definite proof of a deficiency. Symptoms improve dramatically if thiamine deficiency has been causative. Thiamine is nontoxic and doses of 100–500 mg/day produced no adverse side effects.18,19
The Practice of Metabolic Medicine
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Another good example is the patient with Wernicke’s. This is not typically recognized by the hospital care team. And if it is recognized, is generally not treated aggressively enough. There have been many times in my career when I have had to argue with emergency room physicians, hospitalists and even neurologists about the diagnosis and management of this condition. Any time you suspect it, it’s important that you treat it aggressively. And since there is practically no downside to the treatment, the most you are risking is an extra dose of thiamine or two. But if you are right you may have saved someone’s life or at the very least prevent a serious disability.
Nutritional and Dietary Supplementation during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Vitamin B (thiamine) is an essential dietary component because it is a coenzyme. No studies of high doses of thiamine during human pregnancy are published. Thiamine multivitamin supplements were protective against orofacial clefts in the Dutch registry (Krapels et al., 2004). Congenital anomalies were not increased in frequency among offspring of rats given up to 140 times the RDA of thiamine during pregnancy (Morrison and Sarett, 1959; Schumacher et al., 1965) or about 50 times the rat daily requirement. Thiamine deficiency was associated with an increased frequency of fetal death and decreased fetal weight gain among pregnant rats (Nelson and Evans, 1955; Roecklein et al., 1985). Among 98,787 infants born to women who took thiamine supplements during organogenesis, the frequency of orofacial clefts (cleft palate, cleft lip, cleft lip and palate) was not increased (Yoshida et al., 2020).
Efficacy of B-vitamins and vitamin D therapy in improving depressive and anxiety disorders: a systematic review of randomized controlled trials
Published in Nutritional Neuroscience, 2023
Jaqueline G. Borges-Vieira, Camila K. Souza Cardoso
Despite the scarce report in the literature on toxicity caused by B vitamins, attention is required in supplementing these compounds, including monitoring biomarkers concentrations, and following updated recommendations for daily intake. Among the adverse effects documented are diarrhea and yellow-colored urine (vitamin B2); skin flushing (vitamin B3); sensory neuropathy (vitamin B6); diarrhea (B5 in calcium D-pantothenate form) [109]. Vitamin B12 is related to acne development through modulation of the skin microbiota transcriptome in susceptible individuals [110], and anaphylactic reactions after intramuscular administration were documented [111,112]. However, the relationship between long-term folic acid and vitamin B12 supplementation and increased cancer risk is under investigation [113,114], and the role of unmetabolized folic acid in this outcome is studied [115]. The current DRI [83] for thiamine is 1.2 mg per day for men and 1.1 mg per day for women, the upper level (UL) undetermined. For vitamin B6, 1.1 mg/day for both sexes and UL of 100 mg/day. The DRI for folate is 400 mcg/day for both sexes, and UL of 1,000 mcg/day. Furthermore, for vitamin B12, the DRI is 2.4 mcg/day for both sexes, and the UL is indeterminate.
Peripapillary Retinal Haemorrhages in Wernicke’s Encephalopathy Following Bariatric Surgery in a Young Patient
Published in Neuro-Ophthalmology, 2022
Motazz A. Alarfaj, Nada H. Almadhi, Mohammad Al-Amry, Abdullah I. Almater, Majed Al-Obailan
Vitamin B1, or thiamine, is a water-soluble vitamin that functions as a cofactor for energy production. There is a limited intracellular reserve so constant cellular resupply is needed.1 Thiamine deficiency can manifest with two clinical phenotypes: Wernicke-Korsakoff’s syndrome and beriberi. Wernicke’s encephalopathy is characterised classically by a triad of ophthalmoplegia, confusion, and ataxia. Korsakoff’s syndrome (KS) occurs as a late complication of WE and is defined by memory impairment associated with confabulation. KS has a mortality rate of 20% if left untreated. Beriberi may present with congestive cardiac failure (wet beriberi) or polyneuropathy (dry beriberi).1 WE can occur in the setting of poor nutrition or absorption, for example, after bariatric surgery. Whenever there is clinical suspicion, thiamine replacement should be started immediately because of the cognitive consequences of any delay. Herein, we describe a case of WE following laparoscopic sleeve gastrectomy in a young male patient who presented with binocular horizontal diplopia and was found to have preretinal peripapillary haemorrhages.
Fedratinib, the first selective JAK2 inhibitor approved for treatment of myelofibrosis – an option beyond ruxolitinib
Published in Expert Review of Hematology, 2022
The drug SmPC recommends the following mitigating strategy that has been adopted in the subsequent clinical trials too. Thiamine levels and nutritional status should be assessed before starting treatment with Fedratinib, periodically during treatment (e.g. monthly for the first 3 months and every 3 months thereafter) and as clinically indicated. Before initiation and during treatment, thiamine levels should be replenished if low. If encephalopathy suspected, discontinue Fedratinib treatment immediately and initiate parenteral thiamine while evaluating for all possible causes. Monitor patients until symptoms resolve or improve and thiamine levels normalize. The preliminary data from single arm FREEDOM trials shows these strategies to be effective without any more reported cases of WE on Fedratinib [53].