Severe lactic acidosis reversed by thiamine within 24 hours

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Severe lactic acidosis reversed by thiamine within 24 hours

BioMed Central
DOI: 10.1186/cc10495
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CC10495-Amrein.indd Th iamine is a water-soluble vitamin that plays a pivotal role in carbohydrate metabolism. In acute defi ciency, pyruvate accumulates and is metabolized to lactate, and chronic defi ciency may cause polyneuropathy and Wernicke encephalopathy. Classic symptoms include mental status change, ophthalmoplegia, and ataxia but are present in only a few patients [1]. Critically ill patients are prone to thiamine defi ciency because of preexistent malnutrition, increased consumption in high-carbohydrate nutrition, and accelerated clearance in renal replacement. In retrospective [2] and prospective [3,4] studies, a substantial prevalence of thiamine defi ciency has been described in both adult (10% to 20%) and pediatric (28%) patients. Th iamine defi ciency may become clinically evident in any type of malnutrition that outlasts thiamine body stores (2 to 3 weeks), including alcoholism, bariatric surgery, or hyperemesis gravidarum, and results in high morbidity and mortality if untreated [1]. We report the case of a 56-year-old man with profound lactic acidosis that resolved rapidly after thiamine infusion. He was admitted because of a decreased level of consciousness (Glasgow Coma Scale score of 6). Vital signs, including blood pressure, heart rate, and oxygen saturation, were normal. Besides reporting regular alcohol consumption, relatives reported recent progres- sive weakness and 5-kg weight loss. Laboratory fi ndings on admission were remarkable for moderate hypo gly- cemia and metabolic acidosis – pH of 6.87, base excess of –29.5, partial pressure of carbon dioxide (pCO2) of 14 mm Hg – with a high anion gap (37 mmol/L) that was attributed to severe hyperlactatemia (21 mmol/L). After intravenous glucose administration, the patient was transferred to the intensive care unit, where he received sodium bicarbonate and 1,500 mL of lactate-free isotonic crystalloids. Within the next few hours, lactate levels increased further while pH slowly improve

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