Thiamine for altered mental status: a high-value strategy beyond alcohol

Area of Science:

• Neurology
• Internal Medicine
• Critical Care Medicine

Background:

• Altered mental status (AMS) in hospitalized patients requires prompt evaluation.
• Thiamine deficiency, a reversible cause of AMS, is often overlooked, particularly in non-alcohol-associated contexts.
• Contemporary evidence implicates thiamine depletion in diverse patient populations, including medical, surgical, oncologic, obstetric, and critically ill individuals.

Purpose of the Study:

• To highlight the risks of relying solely on alcohol history for diagnosing thiamine deficiency in hospitalized patients.
• To propose a pragmatic, risk-based framework for hospitalists to identify at-risk patients.
• To identify areas for future research regarding thiamine deficiency in AMS.

Main Methods:

• This perspective reviews current evidence linking thiamine deficiency to AMS in various hospitalized populations.
• It discusses the limitations of standard diagnostic tools (MRI, serum thiamine levels) in early disease detection.
• It advocates for a broader clinical approach beyond alcohol history.

Main Results:

• AMS can be the earliest sign of thiamine deficiency in diverse hospitalized groups.
• Standard diagnostic tests may lack sensitivity for early thiamine depletion.
• Delayed recognition of thiamine deficiency can lead to persistent neurological deficits.

Conclusions:

• Early empiric thiamine administration is a high-value, underutilized intervention for hospitalized patients with AMS.
• This approach aligns with principles of high-value care and can prevent irreversible neurological injury.
• A more inclusive, clinically grounded strategy for thiamine assessment is warranted pending further evidence.