Medication Summary

Vitamin and electrolyte replacement is recommended only for specific deficits detected by means of laboratory testing. Thiamine replacement is an exception because it is the only vitamin for which routine administration is recommended and it has been proved useful in patients with chronic alcohol abuse. Thiamine is given to prevent Wernicke syndrome.

Class Summary

Vitamins are organic substances required in small amounts for various metabolic processes. In the body, vitamins may be synthesized in small or insufficient amounts or not at all; thus, supplementation may be required. Vitamins are used in patients with suspected chronic ethanol abuse to prevent serious neurologic complications. If feasible, thiamine should be administered prior to glucose load to reduce risk of Wernicke encephalopathy.

Thiamine (Vitamin B1)

View full drug information

An essential coenzyme of carbohydrate metabolism. Given to all patients with suspected chronic alcohol abuse. Only drug used in patients with ethanol intoxication without a documented deficit. Used in treatment and prevention of Wernicke syndrome.

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The pathway of ethanol metabolism. Disulfiram reduces the rate of oxidation of acetaldehyde by competing with the cofactor nicotinamide adenine dinucleotide (NAD) for binding sites on aldehyde dehydrogenase (ALDH).

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Author

Elizabeth Fernandez, MD Attending Physician, Department of Emergency Medicine, Long Island Jewish Medical Center

Elizabeth Fernandez, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher I Doty, MD, MAAEM, FAAEM, FACEP Tenured Professor of Emergency Medicine, University of Kentucky College of Medicine; Vice Chair of Education, Department of Emergency Medicine, University of Kentucky Chandler Medical Center

Christopher I Doty, MD, MAAEM, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Residency Directors in Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Received salary from Merck for employment.

Chief Editor

Stephen L Thornton, MD Associate Clinical Professor, Department of Emergency Medicine (Medical Toxicology), University of Kansas Hospital; Medical Director, University of Kansas Hospital Poison Control Center; Staff Medical Toxicologist, Children’s Mercy Hospital

Stephen L Thornton, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology

Disclosure: Nothing to disclose.

Additional Contributors

Halim Hennes, MD, MS Division Director, Pediatric Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Director of Emergency Services, Children's Medical Center

Halim Hennes, MD, MS is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

The author gratefully acknowledges the previous coauthors Dr. Sage Wiener and Dr. Binita Shah for their contributions to the development and writing of this article.