Thiamin blood concentrations

The transport system is saturated at relatively low concentrations of thiamin (about 2 /xmol per L), thus limiting the amount of thiamin that can be absorbed. As a result, increasing test doses of thiamin from 2.5 to 20 mg have only a negligible effect on the plasma concentration of thiamin or on urinary excretion. By contrast, the absorption of lipid-soluble aUithiamin derivatives is not apparendy saturable, and they can be used to achieve high blood concentrations of thiamin. 

PDH deficiency results in raised blood concentrations of pyruvate, lactate and alanine. Some patients respond to supplementation with lipoic acid or thiamin (coenzymes for PDH). Treatment with a low carbohydrate, ketogenic diet has been advocated but with limited success. (The ketone bodies readily cross the blood-brain barrier and their catabolism produces acetyl CoA independently of PDH.)... 

Poupon, R.E., Gervaise, G., Riant, P., Houin, G., and Tillement, J.P., 1990. Blood thiamine and thiamine phosphate concentrations in excessive drinkers with or without peripheral neuropathy. Alcohol and Alcoholism. 25 605-611. 

The decarboxylation and oxidation of pyruvate to form acetyl CoA requires the coenzyme thiamin diphosphate, which is formed from vitamin (section 11.6.2). In thiamin deficiency, this reaction is impaired, and deficient subjects are unable to metabolize glucose normally. Especially after a test dose of glucose or moderate exercise they develop high blood concentrations of pyruvate and lactate. In some cases this may be severe enough to result in life-threatening acidosis. 

In the tissues of animals, most thiamine is found as its phosphorylated esteis (4—6) and is piedominandy bound to enzymes as the pyrophosphate (5), the active coen2yme form. As expected for a factor involved in carbohydrate metaboHsm, the highest concentrations ate generally found in organs with high activity, such as the heart, kidney, Hver, and brain. In humans this typically amounts to 1—8 p.g/g of wet tissue, with lesser amounts in the skeletal muscles (35). A typical healthy human body may contain about 30 mg of thiamine in all forms, about 40—50% of this being in the muscles owing to their bulk. Almost no excess is stored. Normal human blood contains about 90 ng/mL, mostly in the ted cells and leukocytes. A value below 40 ng/mL is considered indicative of a possible deficiency. Amounts and proportions in the tissues of other animal species vary widely (31,35). 

At this point, every patient with altered mental status should receive a challenge with concentrated dextrose, unless a rapid bedside blood glucose test demonstrates that the patient is not hypoglycemic. Adults are given 25 g (50 mL of 50% dextrose solution) intravenously, children 0.5 g/kg (2 mL/kg of 25% dextrose). Hypoglycemic patients may appear to be intoxicated, and there is no rapid and reliable way to distinguish them from poisoned patients. Alcoholic or malnourished patients should also receive 100 mg of thiamine intramuscularly or in the intravenous infusion solution at this time to prevent Wernicke s syndrome. 

In a rare autosomal recessive condition (discovered in 1954) the urine and perspiration has a maple syrup odor/ High concentrations of the branched-chain 2-oxoacids formed by transamination of valine, leucine, and isoleucine are present, and the odor arises from decomposition products of these acids. The branched-chain amino acids as well as the related alcohols also accumulate in the blood and are found in the urine. The biochemical defect lies in the enzyme catalyzing oxidative decarboxylation of the oxoacids, as is indicated in Fig. 24-18. Insertions, deletions, and substitutions may be present in any of the subunits (Figs. 15-14,15-15). The disease which may affect one person in 200,000, is usually fatal in early childhood if untreated. Children suffer seizures, mental retardation, and coma. They may survive on a low-protein (gelatin) diet supplemented with essential amino acids, but treatment is difficult and a sudden relapse is apt to prove fatal. Some patients respond to administration of thiamin at 20 times the normal daily requirement. The branched-chain oxoacid dehydrogenase from some of these children shows a reduced affinity for the essential coenzyme thiamin diphosphate.d... 

Botez MI, Joyal C, Maag U, Bachevalier J. Cerebrospinal fluid and blood thiamine concentrations in phenytoin-trea-ted epileptics. Can J Neurol Sci 1982 9(l) 37-9. 

In experimental animals and in depletion studies, measurement of the concentration of thiamin in plasma or whole blood provides an indication of the progression of deficiency. The normal method is by the formation of thiochrome, which is fluorescent ordy free thiamin, and not the phosphates, undergoes... 

Whole blood total thiamin below 150 nmol per L is considered to indicate deficiency. However, the changes observed in depletion studies are small. Even in patients with frank beriberi, the total thiamin concentration in erythrocytes is only 20% lower than normal whole blood thiamin is not a sensitive index of status. 

Thiamine absorption occurs primarily in the proximal small intestine by both a saturable (thiamine transporter) process at low concentration (Ipmol/L, or lower) and by simple passive diffusion beyond that, though percentage absorption diminishes with increased dose. The absorbed thiamine undergoes intracellular phosphorylation, mainly to the pyrophosphate, but at the serosal side 90% of the transferred thiamine is in the firee form. Thiamine uptake is enhanced by thiamine deficiency and reduced by thyroid hormone, diabetes, and ethanol ingestion. The gene for the specific thiamine transporter has been identified, and the transporter cloned. Thiamine is carried by the portal blood to the liver. The firee vitamin occurs in the plasma, but the coenzyme, TPP, is the primary cellular component. Approximately 30 mg is stored in the body with 80% as the pyrophosphate, 10% as triphosphate, and the rest as thiamine and its monophosphate. About half of the body stores are found in skeletal muscles, with much of the remainder in heart, liver, kidneys, and nervous tissues (including the brain, which contains most of the triphosphate). 

Direct measurement of circulating thiamine concentration may be made in plasma, erythrocytes, or whole blood. The plasma (or serum) concentration is thought to reflect recent intake and is mainly unphosphorylated thiamine at low concentration (around 10 to 20nmol/L). Because the erythrocyte contains approximately 80% of the total thiamine content of whole blood,mainly as the pyrophosphate, and erythrocyte thiamine stores deplete at a similar rate to other major organs, HPLC measurement of TPP in erythrocytes is a good indicator of body stores. Typical HPLC methods include a protein precipitation step, precolumn or postcolumn formation of the fluorophore thiochrome, usually with alkaline ferricyanide and isocratic separation. The method is easily standardized with pure... 

Reference intervals for thiamine and its esters depend upon whether (1) erythrocytes, whole blood, or plasma are used as a sample (2) cellular concentrations are expressed per liter of packed red cells or grams of Hb and (3) mass or SI units are used. Some guidance intervals are, for erythrocyte trans-ketolase activity 0.75 to 1.30U/g Hb (48.4 to 83.9kU/mol Hb) and for percent TPP effect (activation), 0 to 15% is normal, 16% to 25% marginally deficient and >25% severely... 

Thiamine is absorbed by a pathway that is saturable at concentrations of 0.5-1.0 jumol/L. Oral doses in excess of 10 mg do not significantly increase blood or urine concentrations of vitamin Bi. In the human, absorption occurs predominantly in the jejunum and ileum. Some ferns, shellfish, fish, and species of bacteria contain thiami-nase, which cleaves the pyrimidine ring from the thiazole ring. This enzyme causes thiamine deficiency in cattle. In plasma, thiamine is transported bound to albumin and, to a small extent, other proteins. TPP is synthesized in the liver by thiamine pyrophosphokinase. 

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