Thiamine Use in Hospitalized Patients: A Clinical Review

Thiamine, or vitamin B1, is a water-soluble vitamin necessary for multiple metabolic processes throughout the human body. Thiamine is primarily obtained from our diet and is found in sources such as whole grains, legumes, and pork. Short bowel syndrome, severe malnutrition, alcohol use disorder, or diuretic use can all lead to thiamine deficiency. Thiamine deficiency may contribute to significant morbidity if not promptly identified and treated. Thiamine supplementation has been established as the primary treatment for patients with Wernicke's encephalopathy. Supplementation of thiamine is also commonly provided to patients at risk for refeeding syndrome to prevent exacerbation of an underlying thiamine deficiency when nutrition is reintroduced. More recent studies have investigated thiamine supplementation for a broader use in patients with sepsis, impaired lactate clearance, and delirium. The purpose of this review is to provide an overview of the indications for thiamine supplementation in hospitalized patients, analyze literature for historical and emerging thiamine supplementation utilization, and provide a framework for supplementation based on indication.