Vitamin B1 (thiamine) is essential for carbohydrate metabolism, ATP production, and neurological function. Severe deficiency causes beriberi and Wernicke's encephalopathy (acute confusion, eye movement abnormalities, ataxia). The body has only 2-3 weeks of thiamine stores.
Deficiency is most common with chronic alcohol use, bariatric surgery, prolonged vomiting, and refined carbohydrate diets. Wernicke's encephalopathy is a medical emergency requiring immediate IV thiamine before any glucose is administered.
FAQs
Should treatment wait for test results in suspected Wernicke's?
No. Wernicke's is a medical emergency requiring immediate IV thiamine. Withholding treatment risks permanent Korsakoff psychosis.
Why is thiamine common in alcohol users?
Alcohol impairs absorption, reduces storage, increases excretion, and is often combined with poor diet, creating multifactorial depletion.
What is Korsakoff syndrome?
The chronic amnestic disorder following untreated Wernicke's encephalopathy, characterised by severe memory impairment and confabulation.
How is thiamine measured?
Whole blood or RBC thiamine is most reliable. Serum thiamine is more variable and less clinically useful.
