Case Report
Volume 4 Issue 8 - 2020
Acute Delirium and Difficult Sedation Weaning in ICU Thiamine Deficiency Maybe a Possible Not Uncommon Cause Case Report
Magdy Khames Aly*
Critical Care Medicine, Alexandria University, Egypt
*Corresponding Author: Magdy Khames Aly, Critical Care Medicine, Alexandria University, Egypt.
Received: June 12, 2020; Published: July 31, 2020


This is a case of 54 years old critically ill H1N1 ARDS patient with prolonged ventilation and sedation and difficult weaning from sedation and mechanical ventilation, The case gives spotlight on not uncommon cause of delirium and failure of weaning in critically ill patients which is Vitamin B1 deficiency and how it is underestimated and should be put in mind while management those patients.

Keywords: Acute Delirium; Acute Confusion State; Thiamine Deficiency; Encephalopathy; Sedation Weaning; Ventilator Weaning; ICU; Critically Ill


  1. Wiley KD and Gupta M. “Vitamin B1 Thiamine Deficiency (Beriberi)”. Stat Pearls (2020).
  2. Wooley JA. “Characteristics of thiamin and its relevance to the management of heart failure”. Nutrition in Clinical Practice 23 (2008): 487-493.
  3. Issel bacher KJ., et al. “Harrison's Principles of Internal Medicine”. 13th New York, NY: McGraw-Hill (1994): 474-475.
  4. McCormick DB., et al. “Modern Nutrition in Health and Disease”. Philadelphia, Pa: Lea and Febiger (1988): 355-361.
  5. Masumoto K., et al. “Need for thiamine in peripheral parenteral nutrition after abdominal surgery in children”. The Journal of Parenteral and Enteral Nutrition 4 (2009): 417-422.
  6. Matrana MR and Davis WE. “Vitamin deficiency after gastric bypass surgery: a review”. Southern Medical Journal 102 (2009): 1025-1031.
  7. Ahmed A., et al. “PS2-02: Micronutrient Deficiencies After Bariatri Surgery: Does Ethnicity Matter?”. Clinical Medicine and Research 3-4 (2011):165.
  8. Francini-Pesenti F., et al. “Wernicke's syndrome during parenteral feeding: not an unusual complication”. Nutrition 25 (2009): 142-146.
  9. Braverman LE and Utiger RD. “Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text”. 7th Baltimore, Md: Lippincott Williams and Wilkins 694 (1996): 864.
  10. Sriram K., et al. “Thiamine in nutrition therapy”. Nutrition in Clinical Practice 1 (2012): 41-50.
  11. Al-Attas OS., et al. “Blood Thiamine and Derivatives as measured by High-Performance Liquid Chromatography: Levels and Associations in DM Patients with Varying Degrees of Microalbuminuria”. Journal of Endocrinological Investigation (2011).
  12. Wiesen P., et al. “Nutrition disorders during acute renal failure and renal replacement therapy”. Journal of Parenteral and Enteral Nutrition 35 (2011): 217-222.
  13. Sica DA. “Loop diuretic therapy, thiamine balance, and heart failure”. Congest Heart Failure4 (2007): 244-247.
  14. Ely EW., et al. “The impact of delirium in the intensive care unit on hospital length of stay”. Intensive Care Medicine 27 (2001): 1892-1900.
  15. Ely EW., et al. “Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit”. The Journal of the American Medical Association 291 (2004): 1753-1762.
  16. Jackson JC., et al. “The association between delirium and cognitive decline: a review of the empirical literature”. Neuropsychology Review 14 (2004): 87-98.
  17. Donnino MW., et al. “Myths and misconceptions of Wernicke’s encephalopathy: what every emergency physician should know”. Annals of Emergency Medicine 6 (2007): 715-721.
  18. Charness ME and DeLaPaz RL. “Mamillary body atrophy in Wernicke’s encephalopathy: antemortem identification using magnetic resonance imaging”. Annals of Neurology 5 (1987): 595-600.
  19. Harper CG., et al. “Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy”. Journal of Neurology, Neurosurgery, and Psychiatry 4 (1986): 341-345.
  20. Victor M., et al. “The Wernicke-Korsakoff Syndrome and Related Neurologic Disorders Due to Alcoholism and Malnutrition”. 2nd Philadelphia, PA: FA Davis (1989).
  21. Isenberg-Grzeda E., et al. “High rate of thiamine deficiency among inpatients with cancer referred for psychiatric consultation: results of a single site prevalence study”. Psychooncology9 (2017): 1384-1389.
  22. Cerejeira J., et al. “The neuroinflammatory hypothesis of delirium”. Acta Neuropathologica 119 (2010): 737-754.
  23. Sharshar T., et al. “Brain lesions in septic shock: A magnetic resonance imaging study”. Intensive Care Medicine 33 (2007): 798-806.
  24. Barr J., et al. “Propofol dosing regimens for ICU sedation based upon an integrated pharmacokinetic-pharmacodynamic model”. Anesthesiology 95 (2001): 324-233.
  25. Brummel NE and Ely EW. “Sedation level and the prevalence of delirium”. Intensive Care Medicine 40 (2014): 135.
  26. Golinger RC., et al. “Association of elevated plasma anticholinergic activity with delirium in surgical patients”. The American Journal of Psychiatry 144 (1987): 1218-1220.
  27. Chang YL., et al. “Prevalence and risk factors for postoperative delirium in a cardiovascular Intensive Care Unit”. American Journal of Critical Care 17 (2008): 567-575.
  28. Patel SB., et al. “Rapidly reversible, sedation-related delirium versus persistent delirium in the Intensive Care Unit”. American Journal of Respiratory and Critical Care Medicine 189 (2014): 658-665.
  29. Kress JP., et al. “Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation”. The New England Journal of Medicine 342 (2000): 1471-1477.
  30. Girard TD., et al. “Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in Intensive Care (Awakening and breathing controlled trial): A randomised controlled trial”. Lancet 371 (2008): 126-134.
  31. Haenggi M., et al. “Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC”. Intensive Care Medicine 39 (2013): 2171-2179.
  32. Sessler CN., et al. “The Richmond agitation-sedation scale: Validity and reliability in adult Intensive Care Unit patients”. American Journal of Respiratory and Critical Care Medicine 166 (2002): 1338-1344.
  33. Hsieh SJ., et al. “The association between acute respiratory distress syndrome, delirium, and in-hospital mortality in Intensive Care Unit patients”. American Journal of Respiratory and Critical Care Medicine 191 (2015): 71-78.
  34. Plaschke K., et al. “Comparison of the confusion assessment method for the Intensive Care Unit (CAM-ICU) with the Intensive Care Delirium Screening Checklist (ICDSC) for delirium in critical care patients gives high agreement rate(s)”. Intensive Care Medicine 34 (2008): 431-436.
  35. Ely EW., et al. “Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the Intensive Care Unit (CAM-ICU)”. The Journal of the American Medical Association 286 (2001): 2703-2710.
  36. Wong CL., et al. “Does this patient have delirium? Value of bedside instruments”. The Journal of the American Medical Association 304 (2010): 779-786.
  37. Pisani MA., et al. “Benzodiazepine and opioid use and the duration of Intensive Care Unit delirium in an older population”. Critical Care Medicine 37 (2009): 177-183.
Citation: Magdy Khames Aly. “Acute Delirium and Difficult Sedation Weaning in ICU Thiamine Deficiency Maybe a Possible Not Uncommon Cause Case Report”. EC Emergency Medicine and Critical Care 4.8 (2020): 48-53.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

October Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the October issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before November 08, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to