The relationship between lactate and thiamine levels in patients with diabetic ketoacidosis

Abstract

Purpose Thiamine functions as an important cofactor in aerobic metabolism and thiamine deficiency can contribute to lactic acidosis. Although increased rates of thiamine deficiency have been described in diabetic outpatients, this phenomenon has not been studied in relation to diabetic ketoacidosis (DKA). In the present study, we hypothesize that thiamine deficiency is associated with elevated lactate in patients with DKA. Materials and Methods This was a prospective observational study of patients presenting to a tertiary care center with DKA. Patient demographics, laboratory results, and outcomes were recorded. A one-time blood draw was performed and analyzed for plasma thiamine levels. Results Thirty-two patients were enrolled. Eight patients (25%) were thiamine deficient, with levels lower than 9 nmol/L. A negative correlation between lactic acid and plasma thiamine levels was found (r = −0.56, P = .002). This relationship remained significant after adjustment for APACHE II scores (P = .009). Thiamine levels were directly related to admission serum bicarbonate (r = 0.44, P = .019), and patients with thiamine deficiency maintained lower bicarbonate levels over the first 24 hours (slopes parallel with a difference of 4.083, P = .002). Conclusions Patients with DKA had a high prevalence of thiamine deficiency. Thiamine levels were inversely related to lactate levels among patients with DKA. A study of thiamine supplementation in DKA is warranted.

Low Thiamine Levels in Children With Type 1 Diabetes and Diabetic Ketoacidosis

“…Twenty-four percent of our patients had low serum thiamine levels on presentation. This is similar to reported prevalence in adults with DKA and lactic acidosis (14), which demonstrated a 25% prevalence of thiamine deficiency and a negative correlation between thiamine level and lactic acidosis. This correlation was not demonstrated in our patients, perhaps due to small sample size.…”

Pyruvate Dehydrogenase Activity and Quantity Decreases After Coronary Artery Bypass Grafting

“…(26) A prominent feature in some cases of thiamine deficiency is severe lactic acidosis which has been described to rapidly resolve with the administration of intravenous thiamine. (27) Our group has previously found a significant inverse relationship between thiamine levels and lactate levels in critical ill patients with diabetic ketoacidosis (28) and sepsis (29). The current study found a similar inverse relationship between thiamine levels and lactate suggesting that thiamine might play an important role in lactate metabolism during major surgery and critical illness.…”

Vitamin B1 in critically ill patients: needs and challenges

“…However, a study by Donnino et al [16] reported a significant negative correlation between lactic acidosis and thiamine levels within a sub population without liver dysfunction. Moskowitz et al [67] also showed a negative correlation on lactate and thiamine levels in patients with diabetic ketoacidosis. Furthermore, there have been several reported cases where a metabolic acidosis has been corrected with thiamine supplementation [68,74,77,78].…”

“…Although cases of beriberi are somewhat of a rarity in modern medicine, there are still populations that are at risk of developing TD. These include patients post-gastric surgery, the elderly, alcoholics, malnourished, diabetics, prolonged hospitalisation, severe fluid loss or fluid replacement therapy [3,15,[67][68][69][70][71].…”