How Does Thiamine Deficiency Result in an Elevated Lactate?

Case A 50-year-old male with a medical history of severe alcohol use disorder and type 2 diabetes mellitus presented to the emergency department with shortness of breath and dry cough. Initial venous blood gases showed a pH of 7.06, anion gap of 41, and lactate of 5.19 mmol/L. After fluid resuscitation, glycemic control, and standard thiamine replacement, the patient’s lactate remained elevated. Overview Elevated lactate is a common finding in hospitalized patients.1   Hyperlactatemia is defined as a serum lactate level greater than 2 mmol/L. Lactic acidosis is elevated lactate in the setting of pH under 7.35.2 The differential diagnosis for elevated lactate is exceedingly broad and thus finding a definitive diagnosis can be difficult, especially in patients with complex medical histories. Generally, high lactate levels can be grouped into two categories: hypoxia, and underlying disease (which can include sepsis, malignancy, thiamine deficiency, liver failure, diabetic ketoacidosis, and alcoholic ketoacidosis). Toxicities from a variety of substances and inborn errors of metabolism should also be considered.1 In this case, the patient presented with lactic acidosis secondary to a variety of potential causes. While the underlying cause of lactic acidosis affects the prognosis greatly, elevated lactate levels are associated with a poor prognosis. In one study, an initial lactate of 4 mmol/L or higher was associated with a 28% in-hospital mortality rate.3 There is no specifi...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: Key Clinical Questions Source Type: research