Early signs and symptoms of deficiency are often nonspecific and vague, such as fatigue, anorexia, nausea, poor memory, sleep disturbance, and lower extremity paresthesia.

Marys Hospital, Richmond, Virginia; President-elect, American Society for Metabolic and Bariatric Surgery.

In the following case, which was not a TMLT case, a lawsuit was filed in Texas against the healthcare professionals caring for a patient, alleging failure to administer thiamine.

She sought treatment from her surgeon, who discovered an anastomotic stricture and successfully performed endoscopic dilation.

Despite the procedure, the patient continued to experience vomiting and was unable to keep down any supplemental nutrients, food, or liquid.

She was made nil per os (NPO), though for nine days following admission to the hospital, she was unable to retain any kind of vitamin or nutrient.

As her 12-day stay at the hospital continued, she began developing several worrisome symptoms, many of which suggested neurological causes, including tingling, fixed gaze, hearing impairment, dizziness, weakness, difficulty walking, altered gait, and nystagmus.

Within one week of her discharge, she was back in the hospital suffering the same symptoms but also with the new onset of delirium, and she became obtunded.

During the second hospital stay, she continued to decline and eventually became unresponsive for a period of time.

She was unable to care for herself or for her 11-year-old daughter.

The plaintiff alleged that the patient was catastrophically and permanently injured as a result of the medical staffs failure to administer thiamine.

At trial, expert testimony concluded that the patient suffered from WE, a serious neurological disorder caused by thiamine deficiency that is characterized by confusion, inability to coordinate voluntary movement, eye abnormalities, memory loss, and other mental deficits.

The plaintiff experts argued the standard of care in this case required that a patient after receiving bariatric surgery who is persistently vomiting should receive thiamine immediately upon admission to prevent this permanent condition.

Both of these complications are 100-percent preventable if adequate thiamine supplementation is ensured.

Even when the patient is already experiencing some or all of the characteristic neurologic changes, immediate administration of therapeutic doses of thiamine can result in complete resolution of those symptoms if given within the first 24 to 48 hours of onset.

There are multiple scenarios that can contribute to the development of WE and beriberi in a patient following bariatric surgery, including the following.

If you think it, give itDont wait to administer thiamineit is cheap and innocuous if the patient does not need it in the end.

In fact, nonsurgeon physicians have occasionally used the defense that it is primarily the duty of the treating bariatric surgeon as the relevant specialist who best understands complications of bariatric surgery and who has the primary responsibility to diagnose and treat nutritional deficiencies caused by the bariatric surgery procedure.

The biologically active form, thiamine pyrophosphate, acts as a coenzyme in carbohydrate metabolism.

The body cannot synthesize thiamine and can only store 30mg, making the human body at risk for quick depletion when nutritional needs are not met.

Several contributing factors can exacerbate thiamine deficiency, including alcohol use, bariatric surgery, vomiting, diarrhea, or inadequate nutritional intake.

Obesity itself can also be considered an independent risk factor.

Adequate thiamine supplementation is found in the form of most standard multivitamin tablets available over the counter, typically 1.5mg per tablet.

Give Thiamine Before Glucose