Objective: Patients with a chronic alcohol use disorder presenting to the ICU may be deficient in important vitamins and electrolytes and are often prescribed a "banana bag" as a reflexive standard of therapy. The difficulty of diagnosing Wernicke's encephalopathy in the critical care setting is reviewed. Furthermore, whether the contents and doses of micronutrients and electrolytes in standard banana bags meet the needs of critically ill patients with an alcohol use disorder is assessed based on available evidence. Data Source: MEDLINE/PubMed (1966 to June 2015) database search, the Cochrane Database of Systematic Reviews, and manual selection of bibliographies from selected articles. Study Selection and Data Extraction: Articles relevant to Wernicke's encephalopathy, vitamin and electrolyte deficiencies in patients with alcohol use disorders, and alcoholic ketoacidosis were selected. Articles were narratively synthesized for this review. Data Synthesis: Of these deficiencies, thiamine is the most important for the practicing clinician to assess and prescribe replacement in a timely manner. Based on a pharmacokinetic assessment of thiamine, the banana bag approach likely fails to optimize delivery of thiamine to the central nervous system. Folic acid and magnesium may also merit supplementation although the available data do not allow for as strong a recommendation as for prescribing thiamine in this setting. There is no available evidence supporting the prescription of a multivitamin. Conclusions: Based on the published literature, for patients with a chronic alcohol use disorder admitted to the ICU with symptoms that may mimic or mask Wernicke's encephalopathy, we suggest abandoning the banana bag and utilizing the following formula for routine supplementation during the first day of admission: 200-500 mg IV thiamine every 8 hours, 64 mg/kg magnesium sulfate (approximately 4-5 g for most adult patients), and 400-1,000 [mu]g IV folate. If alcoholic ketoacidosis is suspected, dextrose-containing fluids are recommended over normal saline. Copyright (C) by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/1S55HV9
Εγγραφή σε:
Σχόλια ανάρτησης (Atom)
Δημοφιλείς αναρτήσεις
-
Publication date: Available online 7 July 2018 Source: The Journal of Emergency Medicine Author(s): Audrey Uong, Ariel Brandwein, Colin C...
-
Abstract Malignant brain tumors are rapidly progressive and often fatal owing to resistance to therapies and based on their complex biolog...
-
Abstract Background Bone flap resorption (BFR) is the most prevalent complication resulting in autologous cranioplasty failure, but no c...
-
Injury from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/1ULgTKC
-
Abstract Non-tumoral portal vein thrombosis (PVT) remains a highly relevant topic in the field of hepatology and liver transplantation wit...
-
Oral Candida colonization in xerostomic post‐radiotherapy head and neck cancer patients 16h ... Oral Candida colonization in xerostomic post...
-
Abstract Objectives Tumor invasion into blood and/or lymphatic vessels, perineural invasion, and histopathological grading are evaluated...
-
Abstract Many methods exist for generating keyframe summaries of videos. However, relatively few methods consider on-line summarisation, w...
-
Abstract Introduction Identifying occurrences of medication side effects and adverse drug events (ADEs) is an important and challenging ...
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου