Vitamin B1 in critically ill patients: needs and challenges

Area of Science:

• Biochemistry
• Clinical Chemistry
• Analytical Chemistry

Background:

• Thiamine (vitamin B1) is vital for energy production.
• Thiamine deficiency (TD) is linked to cardiac failure, neurological disorders, and refeeding syndrome (RFS).
• Accurate thiamine quantification is crucial for patient management, especially in critical illness.

Purpose of the Study:

• To review and analyze analytical methodologies for thiamine compound quantification.
• To identify similarities, variances, and limitations in current thiamine measurement techniques.
• To assess the relevance of these methods for clinical applications in patients.

Main Methods:

• Systematic electronic literature search of Medline, PubMed, and Embase databases.
• Inclusion of articles on thiamine and its phosphate esters, thiamine methodology, and critical illness.
• Inquiry to external quality assurance (EQA) organizations regarding thiamine measurement inclusion.

Main Results:

• 122 articles were included from an initial 777 identified.
• High-performance liquid chromatography (HPLC) with fluorescence detection is the most common method.
• Only two of six EQA programs offer thiamine measurement, focusing solely on whole-blood thiamine pyrophosphate (TPP).

Conclusions:

• There is a significant lack of standardization in thiamine measurement methodologies for clinical practice.
• Method variations hinder the comparison of study results due to a lack of traceability.
• Standardized reference materials and measurement procedures are essential for consistent thiamine analysis and clinical consensus.