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Alcohol and Alcoholism Vol. 36, No. 2, pp. 180, 2001
© 2001 Medical Council on Alcoholism

LETTERS TO THE EDITORS

The value of oral thiamine

J. S. Madden

West Cheshire Hospital, Liverpool Road, Chester CH2 1UL, UK

Received 30 August 2000; accepted 2 October 2000

Cook (2000) advocated parental replacement of thiamine as a routine accompaniment to in-patient alcohol detoxification. The justification is impairment by alcohol of active absorption of the vitamin from the intestine. However, high alcohol intake does not invariably reduce absorption or the effect can be short-lived (Majumdar et al., 1981Go; Baines et al., 1988Go). During their respective studies, Majumdar and colleagues employed a single 50 mg oral dose of thiamine, while Baines and co-workers gave 50 mg by mouth five times a day for 5 days. The high doses administered by both groups ensured the passive absorption of thiamine that is not inhibited by alcohol.

Parenteral thiamine is needed immediately when Wernicke's encephalopathy is present or suspected, and is appropriate for distinct malnourishment. Yet in-patients who undertake detoxification do not automatically fall within these categories. The improvement of the thiamine status that occurs after adequate oral replacement indicates that thiamine by mouth is a satisfactory in-patient (and community) measure when urgent repletion is not required — and one which spares patients and staff the risk and inconvenience of injections.

REFERENCES

Baines, M., Bligh, J. G. and Madden, J. S. (1988) Tissue thiamine levels of hospitalized alcoholics before and after oral or parenteral vitamins. Alcohol and Alcoholism 23, 49–52.[Abstract/Free Full Text]

Cook, C. C. H. (2000) Prevention and treatment of Wernicke– Korsakoff syndrome. Alcohol and Alcoholism 35 (Suppl. 1), 19–20.

Majumdar, S. K., Shaw, G. K. and Thomson, A. D. (1981) Blood vitamin status in chronic alcoholics after a single dose of polyvitamin. A preliminary report. Postgraduate Medical Journal 57, 164–166.[Abstract/Free Full Text]


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