From the Guidelines
Thiamine should be administered to patients with septic shock as an adjunctive therapy, with a recommended dose of 100-300 mg/day IV for 3-4 days, as it has been shown to be beneficial in supporting cellular metabolism and potentially improving outcomes. This recommendation is based on the most recent and highest quality study available, which suggests that thiamine administration should be prescribed without hesitation from admission for patients in emergency or intensive care settings 1. The use of thiamine in septic shock is crucial, as patients often have unrecognized thiamine deficiency, which can worsen lactic acidosis and compromise cardiac function.
Some key points to consider when administering thiamine in septic shock include:
- The dose and duration of thiamine administration, with a recommended dose of 100-300 mg/day IV for 3-4 days 1
- The importance of early administration, as thiamine should be given as soon as possible after admission to maximize its benefits
- The potential benefits of thiamine in supporting aerobic metabolism and improving cardiac output, particularly in patients with risk factors for deficiency such as malnutrition, alcoholism, or chronic diuretic use
- The safety profile of thiamine, which has minimal side effects and is considered a reasonable addition to standard septic shock management alongside antibiotics, fluids, and vasopressors
It is worth noting that some studies have suggested that thiamine may not be beneficial in all cases of sepsis, particularly in children 1. However, the most recent and highest quality study available suggests that thiamine administration is beneficial in supporting cellular metabolism and potentially improving outcomes in patients with septic shock 1. Therefore, thiamine should be administered to patients with septic shock as an adjunctive therapy, with a recommended dose of 100-300 mg/day IV for 3-4 days.
From the Research
Role of Thiamine in Septic Shock
- Thiamine, also known as Vitamin B1, plays a critical role in various biological processes, including glucose metabolism, nucleic acid synthesis, and reduction of oxidative stress 2.
- Thiamine deficiency is common in critically ill patients, affecting up to 70% of them, and is associated with increased illness severity, hyperlactatemia, and poor clinical outcomes 3, 2.
Thiamine Supplementation in Septic Shock
- Thiamine supplementation has been shown to increase lactate clearance and decrease vasopressor dose in patients with septic shock 2, 4.
- However, the current evidence does not support the use of high-dose thiamine as a single therapy or in combination with other micronutrients to improve clinical outcomes in critically ill septic patients 3.
- A study found that thiamine administration within 24 hours of admission in patients with septic shock was associated with improved lactate clearance and a reduction in 28-day mortality compared to matched controls 4.
Combination Therapy with Thiamine
- The combination of thiamine, vitamin C, and corticosteroids has been tested as an adjunctive therapy in septic shock, resulting in a significant decrease in mortality in some studies 2, 5.
- A randomized controlled trial found that the triple combination of hydrocortisone, thiamine, and vitamin C improved clinical outcomes, reduced vasopressor requirements, and increased the rate of improvement of sepsis biomarkers in patients with septic shock 5.