A patient who is thiamine deficient may be refractory to thiamine replacement if hypomagnesemia is also present. Correction of the depleted magnesium stores may be necessary before a response to thiamine can occur.
Magnesium is an essential co-factor for thiamine-dependent enzymes.
Conditions associated with both thiamine and magnesium deficiency may include:
(1) chronic alcoholism
(2) malnutrition
(3) chronic vomiting
Keys to recognition:
(1) failure to respond as suspected to intravenous thiamine replacement
(2) hypomagnesemia
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