Abstract Details

Title Thiamine Administration within University-Affiliated Hospitals: A Retrospective Review of Prescribing Practices

Topic Neurotoxicology

Presentation(s) P01 - (-)

Poster/Presentation
Number 057

Objective

Background Thiamine (vitamin B1) is an essential cofactor for the aerobic metabolism of glucose, and daily requirements are related to metabolic rate and carbohydrate intake. Patients admitted to hospital remain at risk of thiamine deficiency due to the preponderance of risk factors, including poor nutritional intake, increased metabolic demand, and resuscitation with intravenous fluids containing glucose. Thiamine should be administered via the parenteral (intravenous or intramuscular) route to achieve serum levels necessary to reverse the effects of deficiency, and to circumvent problems with absorption common in the medically ill.

Design/Methods Data concerning thiamine administration was obtained through retrospective review of pharmacy records at participating university-affiliated Canadian hospitals over a two-year period (January 2010-December 2011). Protocols governing thiamine prescribing practices were acquired from participating centers. The percentage of thiamine prescribed via the parenteral route (primary outcome measure) was compared across centers (Student's t-Test). Factors associated with higher average rates of parenteral administration (>50%) were investigated through review of hospital-guidelines governing thiamine prescribing.

Results Over 168000 doses of thiamine were prescribed across eight university-affiliated Canadian health centers during the study period. Thiamine was prescribed significantly more often via the enteral route (p=0.01). Parenteral thiamine was prescribed, on average, 28% (±16.5%) of the time (range, 16-59%). The most commonly prescribed dose was 100 mg, independent of route of administration. Three centers boasted rates of parenteral-prescribing >50%. Seven of eight participating centers had protocols in place governing thiamine use; however, only protocols at the top-performing centers prioritized parenteral administration.

Conclusions Oral thiamine continues to be prescribed to patients at risk of deficiency. Protocols prioritizing parenteral administration may improve compliance with evidence-based recommendations. Additional study of factors that may improve rates of parenteral administration is required.

Authors/Disclosures
Gregory S. Day, MD, MSc, FAAN (Mayo Clinic) PRESENTER	Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys Therapeutics. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for DynaMed (EBSCO Health). Dr. Day has or had stock in ANI Pharmaceuticals. The institution of Dr. Day has received research support from National Institutes of Health / NIA. The institution of Dr. Day has received research support from National Institutes of Health / NINDS. The institution of Dr. Day has received research support from Amgen Pharmaceuticals. The institution of Dr. Day has received research support from AVID Radiopharmaceuticals. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Presenter at Annual Meeting (CME) with ��ɫ��. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Content Development (CME) with PeerView, Inc. Dr. Day has received personal compensation in the range of $5,000-$9,999 for serving as a Content Development (CME) with Continuing ��ɫ��, Inc. Dr. Day has received personal compensation in the range of $5,000-$9,999 for serving as a Content Development (CME) with Ionis Pharmaceuticals. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a ��ɫ��al Case Development + Presentation (video) with PeerDirect (P\S\L Group). Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Content Development / Presentation (non-CME) with MJH Life Sciences (NeurologyLive). Dr. Day has a non-compensated relationship as a Clinical Director with Anti-NMDA Receptor Encephalitis Foundation that is relevant to AAN interests or activities.
Safiya Ladak, PharmD (U Health Network, Toronto Western Hospital)	No disclosure on file
Jonathan K. Smith, MD, FAAN (UC Depart of Neurology & Rehabilitation Medicine)	Dr. Smith has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for OBT Law. Dr. Smith has a non-compensated relationship as a Committee Member, Clinical Neurophysiology CMOC Pilot, with ABPN that is relevant to AAN interests or activities.
Kevin Curley, BSC, PHM, MSC, RPH (St. Michael's Hospital)	No disclosure on file
	No disclosure on file

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