Severe type B lactic acidosis and insulin-resistant hyperglycemia related to cadaveric kidney transplantation

Souki, Fouad G.; Ghaffaripour, Sina; Martinez-Lu, Kianfa; Mahmoudi, Hilda

doi:10.1016/j.jclinane.2017.11.024

Cited by 4 publications

(4 citation statements)

References 6 publications

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“…CKD is associated with multiple types of oxidative stress, including mitochondrial dysregulation or reactive oxygen species production, NAPDH oxidases, endothelial NOS uncoupling by uremic toxins, increased xanthine oxidase activity, lipid peroxidation associated with intravenous iron administration, and others . Kidney transplantation has been reported as an inciting stressor for catastrophic lactic acidosis and hyperglycemia in adult populations . Kidney transplant operation and post‐transplant ischemia‐reperfusion injury are associated with signs of increased oxidative stress and with renal dysfunction…”

Section: Discussionmentioning

confidence: 99%

“…Beriberi, including severe presentations including cardiac dysfunction and shock, has previously been noted following renal transplantation in adult patients . Additionally, thiamine deficiency has been associated with delayed graft function following transplant .…”

Section: Discussionmentioning

confidence: 99%

“…Beriberi, including severe presentations including cardiac dysfunction and shock, has previously been noted following renal transplantation in adult patients. 12,13 Additionally, thiamine deficiency has been associated with delayed graft function following transplant. 14 In smaller procedures such as renal allograft biopsies, oxidative stress such as that caused by thiamine deficiency is associated with allograft dysfunction.…”

Section: Picu Admitmentioning

confidence: 99%

“…34 Kidney transplantation has been reported as an inciting stressor for catastrophic lactic acidosis and hyperglycemia in adult populations. 12,13 Kidney transplant operation and post-transplant ischemia-reperfusion injury are associated with signs of increased oxidative stress and with renal dysfunction. 15 Intensive dietary support should have ensured that our patient more than met his daily requirements of vitamins, including thiamine.…”

Section: Picu Admitmentioning

confidence: 99%

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Acute Shoshin beriberi syndrome immediately post–kidney transplant with rapid recovery after thiamine administration

Elias

Sinclair

Blydt‐Hansen

2019

Pediatric Transplantation

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Pediatric kidney transplant surgery is usually well tolerated, despite suboptimal physical conditioning that may result from uremia and nutritional deficiencies that accompany end‐stage kidney failure. Nutritional supplementation is used to overcome such deficiencies, especially for children needing dialysis. Thiamine, a water‐soluble vitamin also known as vitamin B1, is a critical cofactor in energy metabolism and may be competitively inhibited by the antimetabolite oxythiamine, a uremic toxin that accumulates in kidney failure. We report a case of a thiamine deficiency syndrome leading to overwhelming cardiac dysfunction, metabolic instability, and hemodynamic compromise, after otherwise uneventful kidney transplant surgery. Prior to transplant, this 14‐year‐old boy was treated with peritoneal dialysis and received thiamine supplementation. Post‐transplant, the patient first developed hyperglycemia, then lactic acidosis, and subsequently hemodynamic instability despite escalating treatment with volume resuscitation and inotropic medication. He made a rapid and complete recovery after administration of IV thiamine. This is the first reported case of Shoshin beriberi syndrome in a pediatric kidney transplant recipient. Inadequate dialysis may have been a key factor, with toxin accumulation and thiamine transporter downregulation contributing to his status. Functional thiamine deficiency should be considered as a potential treatable cause of early post‐transplant hemodynamic instability.

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