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Another rule is that Z91.81 is for personal history. This is different from family history. Family history of falls (if a parent fell a lot) is not coded with Z91.81

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Accelerated thiamine metabolism is observed in hypermetabolic states, e.g., during withdrawal from alcohol, convulsions, infections, diabetes, or a rapidly developing neoplastic disease, especially of the gastrointestinal tract and the hematopoietic system [5153]

Very slow tapers, sometimes extending over many months, can minimize symptom intensity while allowing neurological adaptation to occur more gradually