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  1. #1
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    demyelination, alcoholism, thiamine, folic acid, magnesium

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    I was observing treatment of an ED patient w/ syncope, intermittent PVC
    (pre ventricular contractions) (single not multiple PVCs), alcoholic, hepC+.
    One of the physicians noticed shaking in the hands and asked if he might
    be going through alcohol withdrawals since he stopped drinking a few days
    before due to not feeling well. His blood pressure was tanking down to
    around 72/60 with oxygenation of about 92%.

    The physician ordered Thiamine, Folic acid, and Magnesium to be infused
    into his IV that was being used to rehydrate him. One of the ER physicians
    said that they did this because of a concern of demyelination. At another
    clinic where I volunteer a family practitioner confirmed this. Initially I was
    concerned about the magnesium infusion because I had just been reading
    about lowering blood pressure with magnesium due to magnesium acting
    like a beta blocker. I read a section in an herbal text that stated that
    magnesium activates vitamin B.

    I know that alcoholics usually have damage to their upper intestine
    where alcohol is absorbed. They may absorb too much iron (wifes nursing
    nutrition textbook). I saw something about possible diminished thiamine
    absorption. Do you have experience with this?

    I also watched the nurse draw blood from an IV line w/o gloves for a known
    hepC+ patient. I watched as some of the blood diffused into the blanket
    where workers were placing various items. I also observed peoples hands
    to see if they had any cuts or scratches. I almost always observe
    universal precautions. For known hepC I know I would have been wearing
    gloves.

  2. #2
    puffin98 is offline Junior Member 510 points
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    Quote Originally Posted by gluconeogenesis
    I was observing treatment of an ED patient w/ syncope, intermittent PVC
    (pre ventricular contractions) (single not multiple PVCs), alcoholic, hepC+.
    One of the physicians noticed shaking in the hands and asked if he might
    be going through alcohol withdrawals since he stopped drinking a few days
    before due to not feeling well. His blood pressure was tanking down to
    around 72/60 with oxygenation of about 92%.

    The physician ordered Thiamine, Folic acid, and Magnesium to be infused
    into his IV that was being used to rehydrate him. One of the ER physicians
    said that they did this because of a concern of demyelination. At another
    clinic where I volunteer a family practitioner confirmed this. Initially I was
    concerned about the magnesium infusion because I had just been reading
    about lowering blood pressure with magnesium due to magnesium acting
    like a beta blocker. I read a section in an herbal text that stated that
    magnesium activates vitamin B.

    I know that alcoholics usually have damage to their upper intestine
    where alcohol is absorbed. They may absorb too much iron (wifes nursing
    nutrition textbook). I saw something about possible diminished thiamine
    absorption. Do you have experience with this?

    I also watched the nurse draw blood from an IV line w/o gloves for a known
    hepC+ patient. I watched as some of the blood diffused into the blanket
    where workers were placing various items. I also observed peoples hands
    to see if they had any cuts or scratches. I almost always observe
    universal precautions. For known hepC I know I would have been wearing
    gloves.
    You might find this review informative and helpful:

    J Emerg Med. 1998 May-Jun;16(3):419-24.Intravenous vitamins for alcoholics in the emergency department: a review.Krishel S, SaFranek D, Clark RF.

    I am sure a pubmed search will offer you even more insight - but a good review is always a good starting point! Good luck.

  3. #3
    MushieCookie is offline Senior Member
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    Yup...and Mg works as a Ca++ antagonist.
    It's used a lot in Obstetrics to help prevent premature delivery.
    It's use is actually '3-fold':
    1. decrease uterine contractions by blocking Ca++ action
    2. lowers blood pressure (vasodilative effect as above); used to lower blood pressure in PIH/pre-eclampsia usually along with some other blood pressure lowering agent (i.e. labetolol)
    3. lowers threshold for seizure in patients with pre-eclampsia/eclampsia.

    just a little fyi

  4. #4
    swimguy23's Avatar
    swimguy23 is offline Elite Member 516 points
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    I saw something about possible diminished thiamine
    absorption. Do you have experience with this?
    perfect USMLE question.....if someone comes in with those symptoms you give IV thiamine

    I also watched the nurse draw blood from an IV line w/o gloves for a known hepC+ patient. I watched as some of the blood diffused into the blanket
    where workers were placing various items. I also observed peoples hands
    to see if they had any cuts or scratches. I almost always observe
    universal precautions. For known hepC I know I would have been wearing
    gloves.
    I feel more comfortable wearing gloves.....the person was stupid for not wearing gloves when drawing blood, esp from someone known to be HepC.....keep in mind that if someone is immunodeficient they can also have higher viral loads, which means that drop of blood has more viruses than someone who isnt immunodeficient
    Hospitalist 2011-2012
    Hematology/Oncology 2012-2015

    some swimmer from Ct Hidden Content
    the problem with the gene pool is that there are too many lifeguards.....and we have been offering swimmies

  5. #5
    microphage's Avatar
    microphage is offline Useless Member 512 points
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    Quote Originally Posted by swimguy23
    perfect USMLE question.....if someone comes in with those symptoms you give IV thiamine


    I feel more comfortable wearing gloves.....the person was stupid for not wearing gloves when drawing blood, esp from someone known to be HepC.....keep in mind that if someone is immunodeficient they can also have higher viral loads, which means that drop of blood has more viruses than someone who isnt immunodeficient
    I thought your fiancee wore gloves around ya?
    Finally beat Super Mario Bros within 7 mins.

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    swimguy23's Avatar
    swimguy23 is offline Elite Member 516 points
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    Quote Originally Posted by microphage
    I thought your fiancee wore gloves around ya?
    only when we're responding to a code in the hospital
    Hospitalist 2011-2012
    Hematology/Oncology 2012-2015

    some swimmer from Ct Hidden Content
    the problem with the gene pool is that there are too many lifeguards.....and we have been offering swimmies

  7. #7
    microphage's Avatar
    microphage is offline Useless Member 512 points
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    Quote Originally Posted by swimguy23
    only when we're responding to a code in the hospital
    is that what you kids are calling it these days?
    Finally beat Super Mario Bros within 7 mins.

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    thiamine insoluble in alcohol, chronic malnutrition

    I found that thiamine is not soluble in alcohol and a thiamine deficiency may cause Wernicke-Korsakoff syndrome or Beriberi.

    "Thiamine or thiamin, also known as vitamin B1, is a colorless compound with chemical formula C12H17N4OS. It is soluble in water and insoluble in alcohol. Thiamine decomposes if heated."
    ...
    "Systemic thiamine deficiency can lead to myriad problems including neurodegeneration, wasting, and death. Well-known syndromes caused by lack of thiamine due to malnutrition or a diet high in thiaminase-rich foods include Wernicke-Korsakoff syndrome and beriberi, diseases also common in chronic abusers of alcohol."
    http://en.wikipedia.org/wiki/Thiamine
    http://en.wikipedia.org/wiki/Wernick...akoff_syndrome
    http://en.wikipedia.org/wiki/Beriberi

    "Heavy alcohol use interferes with the metabolism of thiamine, so even in the unusual cases where alcoholics are eating a balanced diet while drinking heavily, the metabolic problem persists because most of the thiamine is not absorbed."
    http://www.nlm.nih.gov/medlineplus/e...cle/000771.htm

    Thiamine/B1 deficiency
    Thiamine pyrophosphate active form is cofactor in several enzymes for carb and protein catabolism
    Most often seen in alcoholics due to overall malnutrition and alcohol's effects on thiamine

    cardiac Wet beriberi -> high-output caridac failure, peripheral vasodilation, edema
    nervous system Wernick-Korsakoff syndrome -> delirium, ataxia, nystagmus, opthalmoplegia
    may be reversed w/ thiamine, but chronic deficiency results in Korsakoff's syndrome
    No toxicity w/ thiamine seen.
    (Young, Vincent et al, Blueprints Medicine, pg 227)
    Last edited by gluconeogenesis; 12-13-2005 at 06:15 PM.

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    sheikh1's Avatar
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    Are you guys familiar with, bluediaper syndrom. When transportation of tryptophan is faulty.

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    swimguy23's Avatar
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    Quote Originally Posted by gluconeogenesis
    I found that thiamine is not soluble in alcohol and a thiamine deficiency may cause Wernicke-Korsakoff syndrome or Beriberi.

    "Thiamine or thiamin, also known as vitamin B1, is a colorless compound with chemical formula C12H17N4OS. It is soluble in water and insoluble in alcohol. Thiamine decomposes if heated."
    ...
    "Systemic thiamine deficiency can lead to myriad problems including neurodegeneration, wasting, and death. Well-known syndromes caused by lack of thiamine due to malnutrition or a diet high in thiaminase-rich foods include Wernicke-Korsakoff syndrome and beriberi, diseases also common in chronic abusers of alcohol."
    http://en.wikipedia.org/wiki/Thiamine
    http://en.wikipedia.org/wiki/Wernick...akoff_syndrome
    http://en.wikipedia.org/wiki/Beriberi

    "Heavy alcohol use interferes with the metabolism of thiamine, so even in the unusual cases where alcoholics are eating a balanced diet while drinking heavily, the metabolic problem persists because most of the thiamine is not absorbed."
    http://www.nlm.nih.gov/medlineplus/e...cle/000771.htm

    Thiamine/B1 deficiency
    Thiamine pyrophosphate active form is cofactor in several enzymes for carb and protein catabolism
    Most often seen in alcoholics due to overall malnutrition and alcohol's effects on thiamine

    cardiac Wet beriberi -> high-output caridac failure, peripheral vasodilation, edema
    nervous system Wernick-Korsakoff syndrome -> delirium, ataxia, nystagmus, opthalmoplegia
    may be reversed w/ thiamine, but chronic deficiency results in Korsakoff's syndrome
    No toxicity w/ thiamine seen.
    (Young, Vincent et al, Blueprints Medicine, pg 227)
    if you dont know this by the end of basic sciences then you didnt pay attention at all
    Hospitalist 2011-2012
    Hematology/Oncology 2012-2015

    some swimmer from Ct Hidden Content
    the problem with the gene pool is that there are too many lifeguards.....and we have been offering swimmies

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