Many ICU Patients with Alcohol Withdrawal Don't Get Thiamine

Educational Objectives

Summary

Many Patients with Alcohol Withdrawal in Intensive Care Don’t Receive Thiamine

Guidelines recommend routine administration of thiamine in patients admitted to intensive care units (ICUs) with alcohol withdrawal because of concerns for nutritional depletion and risk for Wernicke-Korsakoff syndrome. When patients with alcohol use disorder are admitted to the ICU for other issues (e.g., sepsis, trauma), thiamine administration is not standard practice although there might be similar concerns. To examine how often clinicians give thiamine, investigators examined the records from a multicenter database of nearly 15,000 patients with alcohol use disorder who were admitted to ICUs with alcohol withdrawal, sepsis, diabetic ketoacidosis (DKA), or traumatic brain injury. About two thirds of patients were admitted for alcohol withdrawal alone. Findings appear on the website of the Annals of Internal Medicine (https://doi.org/10.7326/M21-2103).

Overall, half of patients received thiamine supplementation. Sixty percent of patients admitted with only alcohol withdrawal were treated, whereas only one quarter of those admitted for septic shock or DKA (without alcohol withdrawal) received thiamine. A slightly higher percentage (40%) of patients with traumatic brain injury were supplemented. Treatment was initiated within 12 hours of admission in 52% of those who received thiamine; the most common route of administration was enteral.

These data reveal an opportunity to improve the practice of thiamine supplementation in patients hospitalized with alcohol withdrawal. Whether thiamine also should be given routinely to all critically ill patients with alcohol use disorder is unclear; however, clinicians should at least consider it, as thiamine deficiency is easy to overlook when responding to other critical conditions.

Patricia Kritek, MD

Readings

Disclosures

Acknowledgements

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

JW330226

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

More Details - Certification & Accreditation