Vitamin B1 (Thiamine)

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Measures vitamin levels.

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Vitamin B1 (Thiamine) Test Information Guide

Why is it done?
- Measures the level of thiamine (vitamin B1) in the blood to assess nutritional status and metabolic function
- Diagnoses thiamine deficiency which can cause beriberi, Wernicke-Korsakoff syndrome, and neurological complications
- Evaluates symptoms such as weakness, numbness, tingling in extremities, fatigue, memory problems, and muscle weakness
- Assesses risk in patients with chronic alcoholism, malnutrition, malabsorption disorders, dialysis, or hyperemesis gravidarum
- Monitors thiamine status in patients receiving total parenteral nutrition (TPN) or prolonged intravenous therapy
- Typically performed during initial diagnosis of neurological symptoms or in high-risk populations during routine screening
Normal Range
- Normal range: 2.7 - 4.8 mcg/dL (64 - 114 nmol/L) or 25 - 50 ng/mL (depending on laboratory methodology)
- Units of measurement: mcg/dL (micrograms per deciliter), nmol/L (nanomoles per liter), or ng/mL (nanograms per milliliter)
- Normal result: Indicates adequate thiamine stores and no deficiency present
- Low result: Values below normal range indicate thiamine deficiency requiring intervention and supplementation
- High result: Elevated values are uncommon as excess thiamine is water-soluble and excreted in urine; may indicate recent supplementation or therapeutic dosing
- Borderline low: Values slightly below normal may warrant monitoring and dietary assessment to prevent progression to clinical deficiency
- Reference ranges may vary by laboratory; consult specific lab reference values for accurate interpretation
Interpretation
- Low Thiamine Levels (< 2.7 mcg/dL): Indicates thiamine deficiency requiring immediate investigation and treatment. May lead to beriberi (wet or dry form) or Wernicke-Korsakoff syndrome if untreated. Symptoms may include peripheral neuropathy, weakness, cardiac dysfunction, memory loss, and confusion.
- Normal Thiamine Levels (2.7 - 4.8 mcg/dL): Indicates adequate thiamine status with sufficient stores for normal metabolic function. No supplementation typically needed unless patient has ongoing risk factors.
- High Thiamine Levels (> 4.8 mcg/dL): Rarely clinically significant due to water-soluble nature and renal excretion. May reflect recent therapeutic supplementation or high-dose vitamin therapy. No toxicity typically occurs with excess thiamine.
- Factors Affecting Thiamine Levels:
- Chronic alcohol consumption - impairs thiamine absorption and metabolism
- Malabsorption disorders - celiac disease, Crohn's disease, cystic fibrosis reduce thiamine uptake
- Hemodialysis - removes water-soluble vitamins including thiamine
- Medications - diuretics, anticonvulsants, and some chemotherapy agents affect thiamine metabolism
- Poor dietary intake - insufficient consumption of thiamine-rich foods (whole grains, legumes, meat, nuts)
- Hyperemesis gravidarum - severe vomiting in pregnancy prevents nutrient absorption
- Increased metabolic demands - fever, hyperthyroidism, and metabolic stress increase thiamine requirements
- Clinical Significance: Thiamine is essential for carbohydrate metabolism and nervous system function. Deficiency can progress rapidly from subclinical to symptomatic disease, making early detection and treatment critical to prevent irreversible neurological damage.
Associated Organs
- Primary Organ Systems Involved:
- Nervous System (Brain, Peripheral Nerves) - Most severely affected; thiamine is essential for myelin formation and neurotransmitter synthesis
- Cardiovascular System (Heart) - Thiamine deficiency causes dilated cardiomyopathy and wet beriberi with heart failure
- Gastrointestinal System - Involved in nutrient absorption; deficiency impairs GI motility
- Muscles - Thiamine deficiency causes muscle weakness and atrophy
- Associated Diseases and Conditions:
- Beriberi (Wet Form) - Acute cardiac dysfunction with edema, pulmonary congestion, and heart failure
- Beriberi (Dry Form) - Peripheral neuropathy with progressive weakness and paralysis of extremities
- Wernicke-Korsakoff Syndrome - Acute encephalopathy (confusion, ataxia, ophthalmoplegia) progressing to irreversible memory loss and dementia if untreated
- Alcoholic Neuropathy - Chronic alcohol use combined with thiamine deficiency causes distal sensorimotor polyneuropathy
- Lactic Acidosis - Thiamine deficiency impairs pyruvate metabolism leading to metabolic acidosis
- Hyperemesis Gravidarum - Severe pregnancy-related vomiting can lead to thiamine depletion
- Potential Complications of Untreated Deficiency:
- Permanent neurological damage with cognitive impairment and dementia if Wernicke-Korsakoff progresses untreated
- Irreversible peripheral neuropathy with chronic pain and disability
- Acute heart failure and cardiogenic shock from wet beriberi
- Death from cardiac complications if acute beriberi not promptly treated
Follow-up Tests
- Additional Tests Based on Low Thiamine Results:
- Other B Vitamin Levels (B2, B3, B6, B12, Folate) - Thiamine deficiency often occurs with multiple vitamin deficiencies requiring comprehensive assessment
- Comprehensive Metabolic Panel (CMP) - Assess liver function, kidney function, glucose levels, and electrolytes
- Lactate Level - Evaluate for lactic acidosis secondary to impaired pyruvate metabolism
- Albumin and Prealbumin - Assess overall nutritional status and protein reserves
- Electrocardiogram (ECG) - Screen for cardiac arrhythmias and chamber dilatation in suspected wet beriberi
- Echocardiogram - Assess cardiac function and detect dilated cardiomyopathy if heart disease suspected
- Electromyography (EMG) and Nerve Conduction Studies (NCS) - Evaluate for peripheral neuropathy patterns consistent with thiamine deficiency
- Brain MRI - Investigate for characteristic lesions of Wernicke-Korsakoff syndrome (mammillary body and medial thalamic damage)
- Monitoring Frequency:
- During acute supplementation: Repeat thiamine levels after 2-4 weeks of therapy to assess treatment response
- Chronic conditions: Every 3-6 months for patients on long-term supplementation or with ongoing risk factors
- Post-treatment: Quarterly to annual monitoring in alcohol recovery programs to assess adherence and nutritional status
- Dialysis patients: Monthly as part of routine nutritional assessment
- Complementary and Related Tests:
- Transketolase Activity Test - Functional assessment of thiamine status (red blood cell transketolase activity with and without thiamine addition)
- Thiamine Phosphate Esters - Alternative direct assessment of thiamine-dependent cofactor levels
- Complete Blood Count (CBC) - Screen for macrocytic anemia often concurrent with B vitamin deficiencies
Fasting Required?
- Fasting Required: NO
- This test does not require fasting; food and beverage intake do not affect thiamine blood level results
- Meals can be consumed normally before blood draw without impacting test validity
- Medications:
- Thiamine supplementation should be discontinued 24-48 hours before test if possible to obtain accurate baseline levels
- Notify lab and ordering physician of all B vitamins being taken, as supplementation affects results
- Do not discontinue medications prescribed for other conditions without medical approval
- Patient Preparation Instructions:
- Arrive at appointment at scheduled time; no fasting required
- Wear loose-fitting clothing or shirt with easily rolled-up sleeves to facilitate blood draw
- Stay hydrated - drink water before appointment as proper hydration makes vein access easier
- Bring insurance card and photo identification to collection facility
- Inform phlebotomist of any history of fainting, needle anxiety, or difficult venous access
- Sit calmly for 5 minutes before draw to ensure stable vital signs and blood values
- Report timing of last thiamine dose to lab personnel (if applicable) to aid in result interpretation
- For accurate results during supplementation assessment, specimen should be collected before morning dose of thiamine

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