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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