Relationship of blood thiamine pyrophosphate to plasma phosphate and the response to enteral nutrition plus co-administration of intravenous thiamine during critical illness.

Jake T B Collie, Alice Jiang, Yasmine Ali Abdelhamid, Melissa Ankravs, Rinaldo Bellomo, Kathleen M Byrne, Annabelle Clancy, Mark E Finnis, Ronda Greaves, Brianna Tascone, Adam M Deane

Journal: Journal of human nutrition and dietetics : the official journal of the British Dietetic Association 2023;36(4):1214-1224

PMID: 36919646

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Abstract

BACKGROUND

Hypovitamin B1 occurs frequently during critical illness but is challenging to predict or rapidly diagnose. The aim of this study was to evaluate whether plasma phosphate concentrations predict hypovitamin B1, enteral nutrition prevents hypovitamin B1 and intravenous thiamine supplementation achieves supraphysiological concentrations in critically ill patients.

METHODS

Thirty-two enterally fed critically ill patients, with a plasma phosphate concentration ≤0.65 mmol/L, formed a nested cohort within a larger randomised clinical trial. Patients were assigned to receive intravenous thiamine (200 mg) twice daily, and controls were not administered intravenous thiamine. Thiamine pyrophosphate concentrations were measured at four time points (pre- and post-infusion and 4- and 6-h post-infusion) on days 1 and 3 in those allocated to thiamine and once in the control group.

RESULTS

Baseline thiamine pyrophosphate concentrations were similar (intervention 88 [67, 93] vs. control 89 [62, 110] nmol/L, p = 0.49). Eight (25%) patients had hypovitamin B1 (intervention 3 vs. control 5), with two patients in the control group remaining insufficient at day 3. There was no association between baseline phosphate and thiamine pyrophosphate concentrations. Intravenous thiamine achieved supraphysiological concentrations 6 h post first infusion, with concentrations increasing to day 3. In the control group, thiamine pyrophosphate concentrations were not statistically different between baseline and day 3 (mean change: 8.6 [-6.0, 23.1] nmol/L, p = 0.25).

CONCLUSIONS

Phosphate concentrations did not predict hypovitamin B1, which was observed in 25% of the participants. Enteral nutrition alone prevented the development of new hypovitamin B1. Administration of a single 200-mg dose of intravenous thiamine achieved supraphysiological concentrations of thiamine pyrophosphate, with repeated dosing sustaining this effect.

Address: School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia.; Agilent Technologies, Melbourne, Victoria, Australia.; Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.; Department of intensive care, Royal Melbourne Hospital, Melbourne, Victoria, Australia.; Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.; Department of Biochemical Genetics, Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.; Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.

DOI: 10.1111/jhn.13162

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MeSH Terms: Humans, Thiamine, Thiamine Pyrophosphate, Enteral Nutrition, Critical Illness, Phosphates