Supplementary thiamine is still important in alcohol dependence
Ellen Rees 1 , Linda R Gowing
PMID: 23161892
Abstract
Aims: To assess the effect of mandatory thiamine enrichment of wheat flour on blood thiamine levels in an alcohol-dependent population.
Methods: Alcohol-dependent clients (n = 100) entering an inpatient service for the management of alcohol withdrawal had thiamine blood tests and diet interviews. Approximately half (n = 46) the alcohol-dependent participants reported taking vitamin supplements prior to admission. Standard treatment included thiamine supplementation in the form of an intramuscular injection and 100 mg tablets. If consent was gained, a second
thiamine blood test was taken prior to discharge (n = 77). Control participants (n = 20) with no history of treatment for alcohol abuse had thiamine blood tests and diet interviews.
Results: Control participants consumed significantly larger amounts of thiamine in their diet compared with alcohol-dependent participants (P < 0.0001). Alcohol-dependent participants who reported no use of vitamin supplements had significantly lower (P < 0.05) blood thiamine levels compared with controls, whereas controls and those who reported using vitamin supplements had no significant difference. No significant correlation was found between thiamine blood levels and reported levels of alcohol consumption.
Conclusion: Reduced blood levels of thiamine in people who are alcohol dependent, compared with those with no history of alcohol abuse, are likely to be because of the poor diet. Consumption of vitamin supplements appears to bring thiamine levels closer to those seen in control participants. Supplementation of dietary intake of thiamine in people who are alcohol dependent remains an important measure for the prevention of Wernicke-Korsakoff’s syndrome in this population.
Zusammenfassung: Untersuchung der Thiamin-Level im Blut bei 100 alkoholkranken Personen und Vergleich mit einer Kontrollgruppe von 20 Personen ohne C2-Abusus. Thiamin-Level bei C2- Abusus deutlich niedriger, kann aber durch orale oder intramuskuläre Supplementierung an das normale Level angenähert werden.
Fazit: Trotz langer Suche habe ich leider keine Studie zu der Frage gefunden, die mich eigentlich beschäftigt: Ist es sinnvoll, prophylaktisch Vitamin B1 und ggf weitere Vitamine zu supplementieren, wenn eine Reduktion des Alkoholkonsums aktuell ausgeschlossen ist, um zumindest gravierende Spätfolgen wie die Wernicke-Enzephalopathie und das Korsakow- Syndrom zu vermeiden?
Vorschläge anderer Quellen:
- Thiamin 200mg p.o. 2x/d (aus Amboss; zitiert Glöckler et al.: Die Wernicke Enzephalopathie in Ärzteblatt Sachsen, 2016)
- In patients at low risk (with uncomplicated alcohol dependence), oral thiamine 250–500 mg/day should be given for 3–5 days, followed by oral thiamine 100–250 mg/day. (Dervaux, Laqueille: Thiamine (vitamin B1) treatment in patients with alcohol dependence)
Fazit:
Es scheint offensichtlich hilfreich, bei größerem Alkoholkonsum (>1 Bier am Tag) Thiamin zu substituieren. Auch als Marker bei anamnestisch erhöhtem Alkoholkonsum.
Fazit Regen:
Keiner von uns setzt systematisch Thiamin bei Patienten ein. Wir fragen uns, wie viele Patienten mit klinisch relevanten Wernicke Enzephalopathien es überhaupt gibt und wie viele man überhaupt verhindern kann (NNT)?