Basic Concepts of Fluid and Electrolyte Therapy
Basic Concepts of Fluid and Electrolyte Therapy
Basic Concepts of Fluid and Electrolyte Therapy
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Thiamine deficiency<br />
Alcoholic <strong>and</strong> severely malnourished patients are particularly liable to<br />
this complication as they already have low thiamine reserves. Since<br />
this is consumed as a c<strong>of</strong>actor in carbohydrate metabolism, refeeding<br />
particularly with carbohydrate may precipitate symptoms <strong>of</strong> thiamine<br />
deficiency including confusion, cerebellar signs with nystagmus, <strong>and</strong><br />
peripheral neuropathy. These are irreversible once established so that<br />
identification <strong>of</strong> patients at risk <strong>and</strong> the giving <strong>of</strong> prophylactic treatment<br />
are vital. This latter may be achieved by giving 200 mg <strong>of</strong> thiamine<br />
intravenously at the start, followed by 300 mg daily by mouth<br />
or 100 mg intravenously. Thiamine deficiency may also present as wet<br />
beri-beri with heart failure.<br />
Hypomagnesaemia, mild 0.5-0.7 mmol/l, severe
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