Department of Psychiatry, University of North Carolina, Chapel Hill, NC.
Department of Psychiatry, University of North Carolina, Chapel Hill, NC.
Psychosomatics. 2018 Jul-Aug;59(4):379-387. doi: 10.1016/j.psym.2018.01.004. Epub 2018 Jan 11.
Wernicke encephalopathy is a common neuropsychiatric syndrome due to thiamine deficiency. There is no consensus regarding thiamine dosing when Wernicke encephalopathy is suspected. A longstanding dosing strategy for Wernicke encephalopathy is 100mg daily, yet updated clinical guidelines suggest using high-dose intravenous (HDIV) thiamine.
To describe thiamine prescribing practices at a large, public academic hospital and investigate clinical characteristics and outcomes associated with HDIV thiamine in patients with encephalopathy who received IV thiamine.
Electronic medical records of hospitalized patients who received thiamine between 4/4/2014 and 11/1/2015 were reviewed. Chi-square tests, Wilcoxon Rank Sum tests, and logistic regression were used to compare clinical variables in patients with encephalopathy who received HDIV thiamine (≥ 200mg twice daily) vs lower doses of IV thiamine.
Among the total of 5236 thiamine orders, 29% (n = 1531) were IV; 10% (n = 150) of IV orders met HDIV criteria. In patients with encephalopathy who received IV thiamine (n = 432), HDIV thiamine was administered to 20% (n = 86) and only 2.1% (n = 9) received dosing consistent with Royal College of Physicians guidelines. In bivariable analyses, HDIV thiamine was associated with surgical services (p = 0.001), psychiatric consultation (p < 0.001), and decreased mortality (p = 0.004). In multivariable models, the association between HDIV thiamine and decreased in-hospital mortality did not meet statistical significance (p = 0.061).
In a large, public academic hospital, guideline-concordant thiamine supplementation is rare and HDIV thiamine is infrequently prescribed to patients with encephalopathy. Further studies are needed to confirm the possible benefits of HDIV thiamine for patients with suspected thiamine-deficient encephalopathy.
Wernicke 脑病是由于硫胺素缺乏引起的常见神经精神综合征。当怀疑发生 Wernicke 脑病时，硫胺素的剂量尚无共识。长期以来，Wernicke 脑病的剂量方案为每天 100mg，但最新的临床指南建议使用高剂量静脉内（HDIV）硫胺素。
描述一家大型公立学术医院的硫胺素处方实践，并研究接受静脉内硫胺素治疗的脑病患者中与 HDIV 硫胺素相关的临床特征和结局。
回顾了 2014 年 4 月 4 日至 2015 年 11 月 1 日期间住院患者的电子病历，这些患者接受了硫胺素治疗。使用卡方检验、Wilcoxon 秩和检验和逻辑回归比较接受 HDIV 硫胺素（≥200mg 每日两次）与接受较低剂量静脉内硫胺素的脑病患者的临床变量。
在总共 5236 个硫胺素订单中，29%（n=1531）为静脉内；10%（n=150）的静脉内订单符合 HDIV 标准。在接受静脉内硫胺素的脑病患者（n=432）中，20%（n=86）接受了 HDIV 硫胺素治疗，只有 2.1%（n=9）接受了与皇家内科医师学院指南一致的剂量。在单变量分析中，HDIV 硫胺素与外科服务相关（p=0.001），与精神科会诊相关（p<0.001），并降低了死亡率（p=0.004）。在多变量模型中，HDIV 硫胺素与住院期间死亡率降低之间的关联没有达到统计学意义（p=0.061）。
在一家大型公立学术医院中，符合指南的硫胺素补充很少见，HDIV 硫胺素也很少用于脑病患者。需要进一步的研究来证实 HDIV 硫胺素对疑似硫胺素缺乏性脑病患者的可能益处。
