From the Guidelines
Thiamine (Vitamin B1) deficiency can cause lactic acidosis, a potentially life-threatening condition.
Clinical Significance
- Thiamine plays a crucial role in carbohydrate and lipid metabolism, and its deficiency can lead to beriberi, a condition characterized by neurological and cardiovascular symptoms, including lactic acidosis 1.
- Lactic acidosis can occur in patients with thiamine deficiency, particularly in those receiving parenteral nutrition without adequate thiamine supplementation 1.
- The clinical features of thiamine deficiency include congestive cardiac failure and lactic acidosis, which can be severe and even fatal if left untreated 1.
Prevention and Treatment
- Prevention of thiamine deficiency is crucial, especially in patients at risk, such as those with malnutrition, poor oral intake, and chronic alcohol consumption 1.
- IV thiamine 250 mg is recommended to manage encephalopathy in patients with thiamine deficiency, particularly in those with poor absorption due to chronic alcohol ingestion 1.
- Prophylactic thiamine should be administered to patients with predisposing factors, such as rapid weight loss, decreased consumption, and persistent vomiting postoperatively 1.
Key Considerations
- Thiamine deficiency can be prevented by ensuring adequate supplementation, particularly in patients receiving parenteral nutrition or those at risk of deficiency 1.
- Early suspicion and recognition of thiamine deficiency are essential to enable immediate initiation of therapy, as thiamine reserves can be depleted quickly 1.
From the Research
Clinical Significance of Thiamine Deficiency
Thiamine (Vitamin B1) deficiency can cause lactic acidosis, a condition characterized by excessive production of lactic acid or impaired clearance. The clinical significance of thiamine deficiency in causing lactic acidosis is highlighted in several studies:
- Thiamine plays a critical role in energy metabolism, and its deficiency can lead to impaired aerobic respiration and cellular energy production, resulting in lactic acidosis 2, 3.
- Thiamine deficiency is a known cause of lactic acidosis, and it has been evaluated as a potential contributor to refractory lactic acidosis and organ injury in septic shock and other shock states 2.
- Case reports have demonstrated that thiamine deficiency can lead to severe lactic acidosis in pediatric patients, particularly those with underlying medical conditions such as malignant pertussis or acute lymphoblastic leukemia 3, 4.
- Thiamine deficiency should be considered in the differential diagnosis of lactic acidosis, especially in patients receiving parenteral nutrition or those with hematological malignancies 5, 6.
Key Findings
- Thiamine deficiency can cause lactic acidosis due to impaired aerobic respiration and cellular energy production 2, 3.
- Thiamine supplementation can rapidly resolve lactic acidosis in patients with thiamine deficiency 3, 4.
- Thiamine levels are inversely proportional to lactic acidosis, with lower thiamine levels related to higher lactate levels 5.
- Clinicians should be aware of the importance of thiamine in normal glucose metabolism and the potential for thiamine deficiency to lead to lactic acidosis 6.
Patient Populations at Risk
- Pediatric patients with underlying medical conditions such as malignant pertussis or acute lymphoblastic leukemia 3, 4.
- Patients receiving parenteral nutrition, particularly those without adequate vitamin supplementation 6.
- Patients with hematological malignancies, especially those admitted to intensive care units with low blood pressure and lactic acidosis 5.