Comparison of Prehospital Glucose with or without IV Thiamine

Abstract

Introduction: Loading of thiamine prior to glucose administration during hypoglycemia to preventWernicke’s encephalopathy is routine in the prehospital setting. To date no study has looked at thevalidity of this therapy.Methods: We evaluated a retrospective cohort of 242 patients who received intravenous glucose forhypoglycemia comparing those who received thiamine supplementation versus those who did not.Study endpoints were heart rate, blood pressure, Glasgow Coma Scale (GCS), reentry into the 911system, and emergency department (ED) discharge rates.Results: There were no significant differences between the thiamine, and without-thiamine groups.All patients were discharged neurologically intact or were alert and oriented when refusing transportto the hospital. None of the 242 patients re-called 911 within the immediate 24-hour period orreturned to the ED.Conclusion: To our knowledge this is the first study in the literature which evaluated the use ofthiamine with glucose to prevent Wernicke’s encephalopathy in the prehospital setting. We foundthat routine administration of thiamine with glucose did not result in differences in respiratory rate,systolic blood pressure, GCS or ED hospital discharge rates. Until further research is done tovalidate our results emergency medical services leadership should consider whether the routineuse of thiamine in the prehospital setting is appropriate for their system.

Keywords

• emergency medicine
• emergency department
• thiamine
• hypoglycemia