THIAMINE STATUS IN PATIENTS RECEIVING LONG-TERM HOME PARENTERAL-NUTRITION

Objectives: Clinical thiamine deficiency can occur in patients receivi ng total parenteral nutrition (TPN) without thiamine supplementation. Because considerable breakdown of thiamine may occur in the presence o f bisulfite-containing amino acid solutions, subclinical thiamine defi ciency may develop with the use of these solutions, even with appropri ate thiamine supplementation. The current American Medical Association -Food and Drug Administration approved injectable multivitamin formula contains 3 mg of thiamine. This study was undertaken to determine whe ther this quantity of thiamine is sufficient to avoid clinical thiamin e deficiency in long-term home TPN patients with negligible oral thiam ine absorption and in the presence of bisulfite-containing amino acid solutions. Methods: Twenty-four long-term home TPN patients with oral caloric intakes below the norm were evaluated. Seventeen patients suff ered from short bowel syndrome or radiation enteritis, and another thr ee had draining gastrostomies that precluded all intestinal absorption . The duration of TPN therapy ranged between 1 and 164 months. Thiamin e status was assessed by assaying thiamine pyrophosphate, transketolas e activity, and blood thiamine levels. Results: All thiamine pyrophosp hate and erythrocyte transketolase activity levels were within the nor mal range. Conclusions: This study demonstrates that the currently rec ommended 3 mg of thiamine hydrochloride added to TPN solutions is adeq uate to maintain normal thiamine status. This should prevent the devel opment of thiamine deficiency even in patients with compromised intest inal thiamine absorption, and in the presence of bisulfite-containing amino acid solutions.