Thiamine status in patients receiving long-term home parenteral nutrition.
OBJECTIVE
Clinical thiamine deficiency can occur in patients receiving total parenteral nutrition (TPN) without thiamine supplementation. Because considerable breakdown of thiamine may occur in the presence of bisulfite-containing amino acid solutions, subclinical thiamine deficiency may develop with the use of these solutions, even with appropriate thiamine supplementation. The current American Medical Association-Food and Drug Administration approved injectable multivitamin formula contains 3 mg of thiamine. This study was undertaken to determine whether this quantity of thiamine is sufficient to avoid clinical thiamine deficiency in long-term home TPN patients with negligible oral thiamine absorption and in the presence of bisulfite-containing amino acid solutions.


METHODS
Twenty-four long-term home TPN patients with oral caloric intakes below the norm were evaluated. Seventeen patients suffered from short bowel syndrome or radiation enteritis, and another three had draining gastrostomies that precluded all intestinal absorption. The duration of TPN therapy ranged between 1 and 164 months. Thiamine status was assessed by assaying thiamine pyrophosphate, transketolase activity, and blood thiamine levels.


RESULTS
All thiamine pyrophosphate and erythrocyte transketolase activity levels were within the normal range.


CONCLUSIONS
This study demonstrates that the currently recommended 3 mg of thiamine hydrochloride added to TPN solutions is adequate to maintain normal thiamine status. This should prevent the development of thiamine deficiency even in patients with compromised intestinal thiamine absorption, and in the presence of bisulfite-containing amino acid solutions.
Schiano
T D
TD
Department of Medicine, The University of Chicago Medical Center, Illinois 60637, USA.
Klang
M G
MG
Quesada
E
E
Scott
F
F
Tao
Y
Y
Shike
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004912:Erythrocytes / Q000201:enzymology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home; D012016:Reference Values; D013831:Thiamine / Q000008:administration & dosage / Q000097:blood*; D013832:Thiamine Deficiency / Q000517:prevention & control; D013835:Thiamine Pyrophosphate / Q000097:blood; D013997:Time Factors; D014174:Transketolase / Q000097:blood
D014174:Transketolase; D013835:Thiamine Pyrophosphate; D013831:Thiamine