Thiamine Deficiency in Alcoholism

ccurhonda

We are revisiting our policy on querying for Thiamine deficiency in patients with Alcohol dependence/withdrawal. According to "Up to date", Thiamine Deficiency is present in up to 80% of Alcoholics and our Physician and Pharm D have concurred that they consider Thiamine deficiency to be present in Alcoholic patients. Considering this, would you query for Thiamine deficiency as a possible diagnosis with just documentation of Alcohol dependence/withdrawal and the initiation of CIWA/thiamine administration or would you wait to query until documentation of other clinical indicators (irritability, depression, nystagmus etc) which are sometimes poorly documented, vague or attributed to alcohol withdrawal? Just wanting to see how other programs are handling this? Thanks in advance for your input, Rhonda

hooter1964

Great Question. Treatment with IV thiamine should be initiated emergently in any patient in whom the diagnosis is a reasonable consideration, and must be given prior to any glucose administration due to the risk of glucose precipitating or worsening Wernicke’s encephalopathy.
With that being said I would probably wait for more clinical indicators .

The query I use is:

Clinical Indicators:

Please provide a diagnosis associated with the administration of an IV “banana bag” in the emergency department on (date/time) for Mr. X who has a history of “alcoholism” in the next 24 hours or next progress note by documenting your response below:

__ Evidence of thiamine deficiency due to chronic alcohol use/alcoholism

__ Prophylactic treatment of potential thiamine deficiency associated with chronic alcohol use/alcoholism

__ Unable to determine

__ Other please specify