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Alternative Vitamin Repletion in Alcohol Withdrawal

Alternative Vitamin Repletion in Alcohol Withdrawal. Vicki P. Cheng UCI Internal Medicine Residency Cost-Conscious Medicine Series. Chronic Alcohol Abuse. Supportive care: Hydration Correction of electrolyte derangements Nutritional supplementation: Thiamine + glucose

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Alternative Vitamin Repletion in Alcohol Withdrawal

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  1. Alternative Vitamin Repletion in Alcohol Withdrawal Vicki P. Cheng UCI Internal Medicine Residency Cost-Conscious Medicine Series

  2. Chronic Alcohol Abuse • Supportive care: • Hydration • Correction of electrolyte derangements • Nutritional supplementation: • Thiamine + glucose • Multivitamins with folate • Malnourished, high metabolic needs • ?Impaired gastrointestinal absorption • Initial intravenous therapy • Dextrose 5% isotonic saline supplemented with thiamine, folate, and multivitamin • Use not well studied Management of moderate and severe alcohol withdrawal syndromes, Uptodate.com, Hoffman RS, Weinhouse GL. Nov 2013.

  3. Background • Few patients presenting for alcohol-related illness are actually vitamin deficient • Folate (nucleic acid synthesis) • Levels correlates with recent intoxication • Deficiency same as general population • Good GI absorption -> PO Krishel S, SaFranek, Clark RF. Intravenous vitamins for alcoholics in the emergency department: a review. J Emerg Med. 1998;16(3):419-424. • Thiamine (glucose metabolism) • May lack neurologic findings when deficient -> ?IV/IM Li SF, Jacob J, Feng J, Kulkarni M. Vitamin deficiencies in acutely intoxicated patients in the ED. Am J Emerg Med. 2008;26:792-795.

  4. Objective Routine IV multivitamin and folate in alcohol abuse is costly and not supported by evidence Faine B, Nunge M, Denning G, Nugent A. Implementing evidence-based changes in emergency department treatment: alternative vitamin therapy for alcohol-related illnesses. Ann Emerg Med. 2012;59:408-412. • To study current utilization of alternative vitamin therapy routes on the Medicine Wards at UC Irvine

  5. Methods Chart Review • Subjects: All Inpatients on Medicine Teams A-G at UCI Medical Center, 1 day (Block 8) with Diagnosis/Active Problem (n=55) • Alcohol withdrawal (2) • Altered mental status, ALOC • GI Bleed (2) • Pancreatitis • Seizure, Epilepsy Medication Administration Review • Intervention: 0.9% sodium chloride solution 1L with thiamine 100mg inj, multivitamin 10mL inj, folic acid 1mg inj, 1 bag daily x 3 days. May discontinue if tolerating PO. • Comparison: Thiamine 100mg PO daily Folic Acid 1mg PO daily Multivitamin (Tab-a-vite) 1 tab PO daily • Outcome: Appropriate or Inappropriate Route (Tolerating diet?)

  6. Results 2 of 4 patients concurrently receiving both IV and PO vitamins

  7. Conclusion Average Patient Cost per day

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