Thiamine and Lactate

Q: Lactic Acidosis (LA) due to thiamine deficiency may not respond to intravenous sodium bicarbonate.

A) True

B) False

Answer: A

One of the hallmarks of LA secondary to thiamine deficiency is that it may not respond to IV sodium bicarbonate, but only and rapidly to IV thiamine administration.

Thiamine plays an integral role in the metabolism of lactic acidosis. It is a necessary cofactor for two key enzymes in the tricarboxylic acid cycle: pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase. LA secondary to thiamine deficiency is ubiquitous in patients in the ICU receiving total parenteral nutrition (TPN), which usually has a high glucose load.

Overall, there is some weak evidence that IV thiamine enhances the lactate clearance in ICU patients.

#metabolism

#acid-base

References:

1. Centers for Disease Control and Prevention (CDC). Lactic acidosis traced to thiamine deficiency related to nationwide shortage of multivitamins for total parenteral nutrition -- United States, 1997. MMWR Morb Mortal Wkly Rep 1997; 46:523.

2. Salvatori G, Mondì V, Piersigilli F, et al. Thiamine Deficiency in a Developed Country: Acute Lactic Acidosis in Two Neonates Due to Unsupplemented Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2016; 40:886.

3. Woolum JA, Abner EL, Kelly A, et al. Effect of Thiamine Administration on Lactate Clearance and Mortality in Patients With Septic Shock. Crit Care Med 2018; 46:1747.