{"id":19771,"date":"2018-12-03T11:42:36","date_gmt":"2018-12-03T18:42:36","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=19771"},"modified":"2020-07-17T14:45:55","modified_gmt":"2020-07-17T20:45:55","slug":"vitamin-b1-to-the-rescue-to-ward-off-damage-from-alcohol","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/vitamin-b1-to-the-rescue-to-ward-off-damage-from-alcohol\/","title":{"rendered":"Vitamin B1 to the rescue to ward off damage from alcohol"},"content":{"rendered":"
<\/div>

In millions of households across the country, bottles containing multivitamin tablets sit next to the toaster, on a cabinet shelf next to the sugar or some other handy location. They\u2019re a staple for people who want daily diet supplements. Among the familiar substances in those bottles is a secret weapon that also helps people ravaged by alcohol use.<\/p>\n

\"CeDAR
CeDAR nurse Gene Shiling developed a protocol to give vitamin B1 \u0096to alcohol users to prevent a type of brain damage called Wernicke encephalopathy.<\/figcaption><\/figure>\n

It\u2019s vitamin B1, or thiamine, a substance that plays a key role in converting the foods we eat into energy. Most people get plenty of it through their diet or those multivitamin supplements. But thiamine has a small number of enemies. One of them is chronic alcohol consumption, which often leads people to poor nourishment. That means that the body gets less thiamine and also has greater difficulty absorbing and utilizing what it gets of the vitamin.<\/p>\n

Thiamine deficiency, in turn, can lead to acute Wernicke encephalopathy, a form of brain damage that causes confusion, vision problems and difficulty moving. The good news is there is a quick, inexpensive treatment for it: intravenous infusion of thiamine as soon as possible after the symptoms appear. Screening alcohol-use patients for Wernicke encephalopathy and treating those at risk with IV thiamine is now an established protocol at the UCHealth Center for Dependency, Addiction and Rehabilitation<\/a> (CeDAR) on the Anschutz Medical Campus, thanks in large part to the work of CeDAR nurse Gene Shiling.<\/p>\n

Thiamine time<\/strong><\/p>\n

Shiling developed the protocol as a credentialing project for UEXCEL<\/a>, the professional development ladder for nurses at UCHealth University of Colorado<\/a> Hospital<\/u>. It began when he looked at gaps between the time CeDAR admits patients and the time physicians enter orders that initiate treatment. He\u00a0wanted to be sure that all patients admitted for alcohol use who could benefit from Vitamin B1 received it as quickly as possible.<\/p>\n

Shiling was eager to work on the problem because Wernicke encephalopathy is completely reversible once patients receive IV thiamine. In the past, providers often looked for all three of the main symptoms \u2013 loss of control of bodily movements, confusion and vision problems like nystagmus (rapid, uncontrolled eye movements) \u2013 before giving patients treatments. New research shows treatment is beneficial even if patients have just one symptom. Most importantly, the treatment saves brain function and can help to stave off the even more serious Wernicke-Korsakoff syndrome, which permanently damages the brain.<\/p>\n

\u201cThiamine is easy to get and it\u2019s relatively inexpensive,\u201d said Dr. Daniel Bebo, an addiction medicine specialist at CeDAR. \u201cBut the effect of Wernicke encephalopathy and Wernicke-Korsakoff is brain damage. The end result is patients can become non-functional.\u201d<\/p>\n

High-risk population<\/strong><\/p>\n

To illustrate the significance of thiamine treatment in CeDAR\u2019s patient population, Bebo noted that Wernicke encephalopathy appears on autopsy \u2013 the only way to definitely diagnose it \u2013 in between .4 percent and 2.8 percent the general population. For heavy alcohol users, it\u2019s about 12.5 percent, and in those who die alcohol-related deaths, it ranges from 25 percent to 59 percent. Given those numbers, Bebo said, \u201cIt\u2019s curious that thiamine deficiency is still undertreated.\u201d<\/p>\n

Indeed, Shiling said in his research for the UEXCEL project that he couldn\u2019t find another substance use disorder facility anywhere in the country that follows an IV thiamine protocol like the one that he helped to put in place at CeDAR. It includes screening all alcohol-use patients for Wernicke encephalopathy and administering IV thiamine within the 72-hour window to all who exhibit at least one of the three indicators or who are too intoxicated to be screened.<\/p>\n

In addition, Shiling designed training in recognizing Wernicke encephalopathy for all CeDAR nurses and physicians and a tool for assessing the condition that is now in the Epic electronic health record. He also successfully advocated for adding thiamine to the initial order set for physicians.<\/p>\n

Payoff for patients<\/strong><\/p>\n

The results of the work were significant. After implementing the protocol, Shiling analyzed three months of data and found that of 57 patients admitted to CeDAR for alcohol use disorder, 22 received IV thiamine. Another five met the screening standard but did not receive the therapy for a variety of reasons, he said.<\/p>\n

It’s difficult to identify definitively the benefits of the treatment, but for Shiling the \u201cprobable consequences\u201d of thiamine deficiency have been on display during his seven years as a CeDAR nurse. \u201cWe frequently see patients after detox, inpatient care, counseling and multiple modalities of treatment who still have cognitive deficits, but we can\u2019t figure out what they are,\u201d he said.<\/p>\n

In the wider world, Shiling added, the damage caused by Wernicke encephalopathy ranges from increased difficulties for individuals working in fields like accounting and law that require high-level cognitive ability to\u00a0a complete loss of executive function in the most serious cases.<\/p>\n

Shiling and Bebo pointed to the case of a patient who arrived at CeDAR severely intoxicated and exhibited \u201cthe classic triad of symptoms\u201d of Wernicke encephalopathy, as Bebo put it. The patient received IV thiamine treatment within one hour, helping to lead to a positive outcome.<\/p>\n

\u201cOur concern was that he would lose cognitive ability, but he walked out just fine,\u201d Bebo said.<\/p>\n

What if the Wernicke encephalopathy diagnosis is wrong but providers initiate treatment? Well, nothing. If a person gets too much thiamine, the body simply gets rid of it through the call of nature.<\/p>\n

\u201cIf we give thiamine to a whole bunch of people who don\u2019t really need it, there is no harm done,\u201d Shiling said. It\u2019s also inexpensive, he noted. The total cost of the thiamine and supplies to administer it is $89 for a total of six 500-milligram treatments delivered three times a day for two days.<\/p>\n

\u201cAt CeDAR, we\u2019ve said, let\u2019s go ahead and be aggressive,\u201d Bebo said. \u201cGene\u2019s role was to recognize the need and implement a policy that we have adopted. He has also opened up the view to others at CeDAR of research being really important.\u201d<\/p>\n

Professional and personal interest<\/strong><\/p>\n

The project seems to have opened an avenue of interest beyond CeDAR. Shiling presented his work in early October to the annual conference of the International Nurses Society on Addictions and said he received a good response. He\u2019s also submitted it to the American Society of Addiction Medicine<\/a> and to the UCHealth-sponsored Rocky Mountain Interprofessional Research and Evidence-based Practice Symposium<\/a>, which will be held next spring.<\/p>\n

The commitment Shiling has made to patient care also has a personal component. He was a patient at CeDAR in 2009 for treatment of a heroin addiction. In July 2019 he looks forward to celebrating a decade of sobriety.<\/p>\n

\u201cI feel like I can relate to our patients on a personal level,\u201d he said. \u201cI know what it feels like to be in their shoes, what it feels like to have to give up control and surrender, to take advice from strangers and have people tell you how to live your life and how difficult that is.\u201d<\/p>\n

His commitment has not gone unnoticed at UCHealth. \u201cIt\u2019s very exciting to see the impact our clinical nurses are making with patient outcomes when they lead quality improvement work,\u201d said Danielle Schloffman, director of the Magnet Program for nursing at UCH. \u201cOne goal of the UEXCEL credentialing program is to support direct care nurses to improve care delivery. Gene\u2019s dedication to evidenced-based practice and his passion for improving lives for this vulnerable patient population is exemplary. Due to his efforts, patients are receiving preventative treatment that may have lasting positive effects on their overall health and wellbeing.\u201d<\/p>\n

Those words sum up Shiling\u2019s primary motivation as a nurse at CeDAR. \u201cWe\u2019re trying to give people better quality of life,\u201d he said. \u201cIf we save just one person, I\u2019ve done my job.\u201d<\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

In millions of households across the country, bottles containing multivitamin tablets sit next to the toaster, on a cabinet shelf next to the sugar or some other handy location. They\u2019re a staple for people who want daily diet supplements. 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