4.4 Alcoholism

Case Study (continued)

Upon questioning the family revealed that the patient had a history of depression and alcoholism. Although Celexa (20 mg daily) had been prescribed to treat the depression the patient had not been compliant with the doctor’s recommendation.  Prior to the accident the patient drank at least 6 beers each day and a case of 24 on the weekends. He lives alone and his eating habits are poor.

4.4.1 Complications of Alcoholism

Provide a potential list of problems arising out of the patient’s history of alcoholism and depression.

Given the patients history of alcohol abuse and depression issues that might be seen include:

  • Withdrawal from alcohol;
     
  • Malnutrition or nutritional deficiencies;
     
  • Vitamin B1 and B6  deficiencies;
     
  • Noted increase in depressive symptoms as they are no longer masked by an alcohol dependency

4.4.2   Thiamin Supplementation

Case Study (continued)

Once in rehabilitation, Vitamin B 1 was administered to boost thiamin.

Why would thiamin be important in this case?

  1. Vitamin B1 is an essential vitamin obtained through diet;
     
  2. Alcoholics frequently suffer from thiamine deficiency;
     
  3. Prolonged lack of thiamine can affect the brainstem, cerebellum, thalamus, hypothalamus and mamillary bodies.

How does alcoholism induce thiamin deficiency?

  1. Alcoholism may contribute to thiamine deficiency by causing an inadequate nutritional intake, by decreasing the absorption of thiamine from the gastrointestinal tract and reducing its uptake into cells. 
     
  2. Alcoholism may also lead to an impaired utilization of thiamine in the cells 14.
  • Thiamin (vitamin B1) is an essential vitamin, which is not produced in the body and must be ingested with our diets.
     
  • It is currently recommended for adults a minimum of 1mg of thiamin per day 15; however, it has been found that alcoholics have a tendency to consume less than 0.29 mg/1000 Kcal of thiamin 16
     
  • Alcoholism may further contribute to thiamine deficiency by decreasing the absorption of thiamine from the gastrointestinal tract and reducing its uptake into cells.  Alcoholism may also lead to an impaired utilization of thiamine in the cells 14
     
  • Areas of the brain that may be affected by a thiamin deficiency include the: brain stem, cerebellum, thalamus, hypothalamus and mamillary bodies14
     
  • Therefore, when an alcoholic with a brain injury is admitted to rehabilitation, there should be a high suspicion for malnutrition in general and thiamine deficiency in particular. 
     
  • Clinically the patient should be assessed for the presence of anemia and a serum vitamin B12 level and thiamine (vitamin B1) supplementation (50 – 100 mg per day) should be initiated. Consider also a daily multivitamin/mineral supplement.