• geriatrics;
  • thiamine;
  • emergency department


  1. Top of page
  2. Abstract
  3. References

Abstract. Objectives: To determine the prevalence of thiamine deficiency in a high-risk group of elder emergency department (ED) patients who reside in nursing homes and need admission to the hospital, and to determine the effect of patients diets on this prevalence. Methods: This was an observational pilot study of 75 consecutive ED patients aged 65 years or older who lived in a nursing home and were admitted to the hospital. Plasma thiamine levels were measured by high-pressure liquid chromatography on serum samples collected within 24 hours of hospital admission. Nursing home records were reviewed to determine whether patients received nutritional supplementation or enteral tube feedings. Results: Seventy patients participated and had a mean plasma thiamine level of 27.3 μ/dL (95% CI = 20.2 to 34.4). Fourteen percent (n= 10, 95% CI = 8% to 24%) were thiamine-deficient (<10 μg/dL). Patients not receiving dietary supplements or tube feedings (n= 26) had lower mean thiamine levels (20.3 μg/dL, 95% CI = 12.7 to 27.9) and were thiamine-deficient more often (27%) than patients receiving dietary support (n= 44, 31.5 μg/dL, 95% CI = 24.7 to 38.3, 7% thiamine-deficient). Conclusions: Elder nursing home patients seen in the ED and admitted to the hospital are frequently thiamine-deficient. Empiric thiamine supplementation is often used in the ED for other high-risk patients, such as alcoholic individuals, and may be appropriate for high-risk elder patients. Further research is needed to determine whether thiamine supplementation in these patients can improve their clinical outcomes.


  1. Top of page
  2. Abstract
  3. References
  • 1
    Cravioto H, Korein J, Silberman J. Wernicke's encephalopathy: a clinical and pathological study of 28 autopsied cases. Arch Neurol. 1961; 4: 5109.
  • 2
    Torvik A, Lindboe CF, Rodge S. Brain lesions in alcoholics: a neuropathological study with clinical correlations. J Neurol Sci. 1982; 56: 23348.
  • 3
    Victor M, Laureno R. Neurologic complications of alcohol abuse: epidemiological aspects. In: SchoenbergB (ed). Advances in Neurology, Vol 19. New York : Raven Press, 1978, pp 60317.
  • 4
    Faris AA. Wernicke's encephalopathy in uremia. Neurology. 1972; 22: 12937.
  • 5
    Descombes E, Dessibourg CA, Fellay G. Acute encephalopathy due to thiamine deficiency (Wernicke's encephalopathy) in a chronic hemodialyzed patient: a case report. Clin Nephrol. 1991; 33: 1715.
  • 6
    Haid RW, Gutmann L, Crosby TW. Wernicke-Korsakoff encephalopathy after gastric plication. JAMA. 1982; 247: 25667.
  • 7
    Lavin PMJ, Smith D, Kori SH, Ellenberger C. Wernicke's encephalopathy: a predictable complication of hyperemesis gravidarum. Obstet Gynecol. 1983; 62(3 suppl): 13s15s.
  • 8
    Darnton-Hill I, Truswell AS. Thiamine status of a sample of homeless clinic attenders in Sydney. Med J Aust. 1990; 152: 59.
  • 9
    Ishi K, Sarai K, Sanemori H, Kawasaki T. Analysis of thiamine and its phosphate esters by high-performance liquid chromatography. Anal Biochem. 1979; 97: 1915.
  • 10
    Bessman ES. Malnutrition in geriatric emergency department patients [abstract]. Ann Emerg Med. 1998; 32(3 suppl): S42S43.
  • 11
    Rosenberg IH, Miller JW. Nutritional factors in physical and cognitive functions of elderly people. Am J Clin Nutr. 1992; 55(6 suppl): 1237S1243S.
  • 12
    Vellas BJ, Albarede JL, Garry PJ. Diseases and aging: patterns of morbidity with age; relationship between aging and age-associated diseases. Am J Clin Nutr. 1992; 55(6 suppl): 1225S1230S.
  • 13
    Nichols HK, Basu TK. Thiamine status of the elderly: dietary intake and thiamine pyrophosphate response. J Am Coll Nutr. 1994; 13(1): 5761.
  • 14
    Elmstahl S, Steen B. Hospital nutrition in geriatric long-term care medicine: II. Effects of dietary supplements. Age Ageing. 1987; 16: 7380.
  • 15
    Kwok T, Falconer-Smith JF, Potter JF, Ives DR. Thiamine status of elderly patients with cardiac failure. Age Ageing. 1992; 21: 6771.
  • 16
    Brady JA, Rock CL, Horneffer MR. Thiamine status, diuretic medications, and the management of congestive heart failure. J Am Diet Assoc. 1995; 95: 5414.
  • 17
    Gambert SR. Alcohol abuse: medical effects of heavy drinking in late life. Geriatrics. 1997; 52(6): 307.
  • 18
    Colsher PL, Wallace RB. Elderly men with histories of heavy drinking: correlates and consequences. J Stud Alcohol. 1990; 51: 5285.
  • 19
    Vir SC, Love AHG. Thiamine status of institutionalized and non-institutionalized aged. Int J Vit Nutr Res. 1977; 47: 32535.
  • 20
    Bianchetti A, Rozzini R, Carabellese C, Zanetti O, Trabucchi M. Nutritional intake, socioeconomic conditions and health status in a large elderly population. J Am Geriatr Soc. 1990; 38: 5216.
  • 21
    Baker H, Frank O, Third IS, Jaslow SP, Louria DB. Vitamin profiles in elderly persons living at home or in nursing homes, versus profile in healthy young subjects. J Am Geriatr Soc. 1979; 26: 44450.
  • 22
    Chen MF, Chen LT, Gold M, Boyce HW. Plasma and erythrocyte thiamine concentrations in geriatric outpatients. J Am Coll Nutr. 1996; 15: 2316.
  • 23
    Goodwin JS, Goodwin JM, Garry PJ. Association between nutritional status and cognitive functioning in a healthy elderly population. JAMA. 1983; 249: 291721.
  • 24
    Seligmann H, Halkin H, Rauchfleisch S, et al. Thiamine deficiency in patients with congestive heart failure receiving long-term furosemide therapy: a pilot study. Am J Med. 1991; 91: 1515.
  • 25
    Shimon I, Almog S, Vered Z. Improved left ventricular function after thiamine supplementation in patients with congestive heart failure receiving long-term furosemide therapy. Am J Med. 1995; 98: 48590.
  • 26
    Wrenn K, Murphy F, Slovis CM. A toxicity study of parenteral thiamine hydrochloride. Ann Emerg Med. 1989; 18: 86770.
  • 27
    Centerwall BS, Criqui MH. Prevention of the Wernicke-Korsakoff syndrome: a cost-benefit analysis. N Engl J Med. 1978; 299: 2859.