Lactic acidosis in thiamine deficiency.

Area of Science:

• Clinical Medicine
• Biochemistry
• Nutritional Science

Background:

• Prolonged lactic acidosis in chronically ill patients with poor nutritional intake can be challenging to diagnose.
• Thiamine deficiency is a potential, often overlooked, cause of metabolic derangements.

Purpose of the Study:

• To investigate the role of thiamine deficiency in unexplained lactic acidosis and heart failure in malnourished patients.
• To assess the efficacy of thiamine supplementation in reversing these conditions.

Main Methods:

• Case study of two chronically ill patients with prolonged lactic acidosis and limited nutritional intake.
• Diagnostic evaluation including assessment for other causes of hyperlactaemia.
• Biochemical confirmation of thiamine deficiency via erythrocyte transketolase activation assay.
• Echocardiography to assess cardiac function before and after thiamine treatment.
• Thiamine supplementation (600 mg) administered to both patients.

Main Results:

• Rapid normalization of serum lactate levels and acid-base status following thiamine supplementation.
• Significant reduction in erythrocyte transketolase activation by thiamine pyrophosphate post-treatment, confirming deficiency.
• Reversible right ventricular heart failure, evidenced by echocardiography, improved rapidly with thiamine therapy.

Conclusions:

• Unexplained prolonged lactic acidosis in malnourished patients can be a manifestation of thiamine deficiency.
• Thiamine replacement therapy is effective in rapidly correcting lactic acidosis and associated cardiac dysfunction.
• Highlights the critical role of thiamine in preventing and treating metabolic complications in malnutrition.