WESTPORT, CT (Reuters Health) – Thiamine deficiency may account for many cases of unexplained encephalopathy in patients receiving hemodialysis or peritoneal dialysis for end-stage renal disease.
Dr. Der-Cherng Tarng from Taipei Veterans General Hospital in Taiwan and colleagues analyzed the potential causes of unexplained encephalopathy in 30 consecutive patients admitted to their hospital because of altered mental status. Ten of the patients received a tentative diagnosis of unexplained encephalopathy after the initial work-up.
Nausea and vomiting often heralded the onset of mental abnormalities, which included chorea, acute visual acuity loss, rapidly progressive dementia, myoclonic jerking, convulsions, and altered mental status ranging from behavior change to stupor, the authors report in the American Journal of Kidney Diseases for November.
As a group, these patients had low serum albumin levels and low predialysis blood urea nitrogen levels along with elevated plasma lactate levels.
All 10 patients had thiamine deficiency, the researchers note. In a subgroup of seven patients, they verified that serum thiamine levels (mean 35.3 nmol/L) were significantly lower than those of hemodialysis controls (85.6 nmol/L, p < 0.001) or healthy subjects (96.8 nmol/L, p < 0.005). Nine of the 10 patients experienced dramatic resolution of their neurological deficits after thiamine replacement (200 mg intravenously, followed by 100 mg/day).
Dr. Tarng told Reuters Health that he recommends routine administration of thiamine for dialysis patients with the following conditions:
— Malnutrition
— Poor oral intake with gastroenteropathy
— Increased metabolic demand for thiamine during infections, surgery, and glucose loading
— Unexplained neurological symptoms
— Unexplained heart failure with fluid overload
— Unexplained peripheral neuropathy
"Our study indicates that thiamine deficiency is common in dialysis patients, but the atypical presentation and clinician's unawareness may lead to a delay in diagnosis," said Dr. Tarng. "Clinical evaluation of dialysis patients with encephalopathy or acutely altered consciousness should include the possibility of thiamine deficiency. This condition is fatal if unrecognized and can be successfully treated with prompt thiamine replacement."
Am J Kidney Dis 2001;38:941-947.
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