Thiamine Deficiency Leading to Refractory Lactic Acidosis in a Pediatric Patient

Area of Science:

• Biochemistry
• Pediatric Critical Care

Background:

• Thiamine (vitamin B1) is essential for cellular energy metabolism.
• Thiamine deficiency can lead to severe lactic acidosis and increased mortality in critically ill individuals.
• Lactic acidosis in neonates often presents diagnostic challenges.

Observation:

• A term neonate with malignant pertussis, requiring extracorporeal membrane oxygenation and continuous renal replacement therapy, developed profound lactic acidosis.
• Extensive evaluations failed to identify the etiology of the lactic acidosis.
• The neonate was ultimately diagnosed with thiamine deficiency.

Findings:

• Thiamine deficiency was the underlying cause of severe lactic acidosis in this critically ill neonate.
• Vitamin B1 supplementation led to a rapid resolution of the lactic acidosis.
• This case highlights a rare but critical complication of thiamine deficiency.

Implications:

• Thiamine deficiency should be considered in the differential diagnosis of unexplained lactic acidosis in critically ill neonates.
• Early diagnosis and treatment of thiamine deficiency can prevent severe metabolic derangements and improve outcomes.
• This case underscores the importance of assessing vitamin status in critically ill pediatric patients.