Thiamine

Provider Level

RN/Paramedic

Class

Vitamin, Nutritional Supplement

Mechanism of Action

An essential water-soluble vitamin (B1) that combines with ATP to form thiamine pyrophosphate. This coenzyme is necessary for normal carbohydrate metabolism. The brain is extremely sensitive to thiamine deficiency.

Indications

Suspected Wernicke-Korsakoff syndrome, chronic alcoholism with altered mental status, malnourished patients presenting with coma, prophylactic administration before or with IV dextrose in susceptible patients.

Contraindications

Known hypersensitivity to thiamine products.

Routes

IV, IM, IO, PO

Onset / Duration

Onset is rapid following IV administration. Duration varies depending on the degree of tissue depletion.

Adverse Effects

Generally well tolerated. Rare adverse effects include anaphylaxis (more common with rapid IV push), sensation of warmth, pruritus, diaphoresis, nausea, and weakness.

Precautions & Interactions

Rapid IV push may cause hypotension or anaphylaxis; administer slowly. It is classically taught to administer thiamine prior to or concurrently with dextrose in malnourished or alcoholic patients to prevent precipitation of Wernicke encephalopathy, though life-saving dextrose should never be delayed.

Special Considerations

Authorized for RN/Paramedic use. Water-soluble vitamin, so excess is excreted in urine. Rarely causes toxicity.