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Tiamina para el estado mental alterado: una estrategia de alto valor más allá del alcohol
1University of Tennessee Hospitalist, University of Tennessee Medical Center, Knoxville, TN, USA.
Postgraduate medicine
|February 14, 2026
Resumen
La deficiencia de tiamina es una causa subestimada de alteración del estado mental (AEM) en pacientes hospitalizados más allá de aquellos con abuso de alcohol. La administración empírica temprana de tiamina es una intervención segura y de bajo costo para prevenir el daño neurológico irreversible.
Área de la Ciencia:
- Neurología
- Medicina Interna
- Medicina de Cuidados Críticos
Sus antecedentes:
- La alteración del estado mental (AEM) en pacientes hospitalizados requiere una evaluación rápida.
- La deficiencia de tiamina, una causa reversible de AEM, a menudo se pasa por alto, especialmente en contextos no asociados con el alcohol.
- La evidencia contemporánea implica la depleción de tiamina en diversas poblaciones de pacientes, incluidos individuos médicos, quirúrgicos, oncológicos, obstétricos y críticamente enfermos.
Objetivo del estudio:
- Destacar los riesgos de depender únicamente de los antecedentes de consumo de alcohol para diagnosticar la deficiencia de tiamina en pacientes hospitalizados.
- Proponer un marco pragmático y basado en el riesgo para que los médicos de hospital identifiquen a los pacientes en riesgo.
- Identificar áreas para futuras investigaciones sobre la deficiencia de tiamina en la AEM.
Principales métodos:
- Esta perspectiva revisa la evidencia actual que relaciona la deficiencia de tiamina con la AEM en diversas poblaciones hospitalizadas.
- Analiza las limitaciones de las herramientas de diagnóstico estándar (RM, niveles de tiamina en suero) en la detección temprana de la enfermedad.
- Aboga por un enfoque clínico más amplio más allá de los antecedentes de consumo de alcohol.
Principales resultados:
- La AEM puede ser el primer signo de deficiencia de tiamina en diversos grupos de pacientes hospitalizados.
- Las pruebas de diagnóstico estándar pueden carecer de sensibilidad para la depleción temprana de tiamina.
- El retraso en el reconocimiento de la deficiencia de tiamina puede provocar déficits neurológicos persistentes.
Conclusiones:
- La administración empírica temprana de tiamina es una intervención de alto valor y subutilizada para pacientes hospitalizados con AEM.
- Este enfoque se alinea con los principios de atención de alto valor y puede prevenir lesiones neurológicas irreversibles.
- Se justifica una estrategia más inclusiva y clínicamente fundamentada para la evaluación de la tiamina a la espera de más evidencia.
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