We thank Dr. Morton for his letter regarding thiamine deficiency and bariatric surgery.We agree that thiamine supplementation is of importance in patients at risk of deficiency such as in cases of malnutrition from decreased nutrient intake, increased nutrient losses, or impaired nutrient absorption. Clinical conditions where this may occur include starvation, hyperemesis gravi-darum, and bariatric surgery.1 Our institution does not routinely conduct laboratory assessments of thiamine status. As described in the Journal of Parenteral and Enteral Nutrition tutorial on thiamine, in the acute care setting reliable laboratory tests are not available, are costly, and can be impractical due to the long turnaround time.1 Therefore, a clinical assessment of thiamine deficiency is conducted and the patient is treated if signs and symptoms point to a suspected deficiency. In addition, empiric treatment should be considered if the patient has evidence of malnutrition, even in the absence of symptoms of thiamine deficiency. In the case of our patient, the individual was indeed treated with parenteral thiamine during the commencement of total parenteral nutrition as she presented with malnutrition.
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