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Vitamin C and thiamine levels in patients presenting with acute neurologic syndromes. Am J Med Sci 2021; 362:621-623. [PMID: 34119516 DOI: 10.1016/j.amjms.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 05/03/2021] [Accepted: 06/07/2021] [Indexed: 11/21/2022]
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Sedhai YR, Shrestha DB, Budhathoki P, Jha V, Mandal SK, Karki S, Baniya R, Cable CA, Kashiouris MG. Effect of thiamine supplementation in critically ill patients: A systematic review and meta-analysis. J Crit Care 2021; 65:104-115. [PMID: 34118501 DOI: 10.1016/j.jcrc.2021.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/31/2021] [Accepted: 05/26/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Several studies have previously shown the benefit of thiamine supplementation in critically ill patients. In order to fully appraise the available data, we performed a meta-analysis of 18 published studies. METHODS A thorough systematic search was conducted. The studies enrolling critically ill patients receiving thiamine supplementation was compared with the standard of care (SOC) group. Data was analyzed using RevMan 5.4. Clinical outcomes were pooled using Odds Ratio (OR) and mean differences. RESULT Eighteen studies (8 RCTs and 10 cohort studies) met the criteria for quantitative synthesis. In the analysis of RCTs, thiamine supplementation showed 42% lower odds of developing ICU delirium (OR 0.58, 95% CI, 0.34-0.98). A reduction in mortaliy was observed on performing fixed effect model analysis however, a level of statistical significance could not be reached on performing randon effect model analysis (OR, 0.78; 95% CI, 0.59 to 1.04). Further sub-group analysis of 13 studies in patients with sepsis, there was no difference in mortality between the two groups (OR, 0.83; 95% CI, 0.63 to 1.09). CONCLUSION Thiamine supplementation in critically ill patients showed a reduction in the incidence of ICU delirium among RCTs. However, there was no significant benefit in terms of overall mortality, and mortality in patients with sepsis. Further, large scale randomized prospective studies are warranted to investigate the role of thiamine supplementation in critically ill patients.
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Affiliation(s)
- Yub Raj Sedhai
- Department of Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA.
| | | | - Pravash Budhathoki
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA
| | - Vivek Jha
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal
| | - Sujit Kumar Mandal
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal; Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | | | - Ramkaji Baniya
- Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA
| | - Casey A Cable
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, VCU School of Medicine, Richmond, VA, USA
| | - Markos G Kashiouris
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, VCU School of Medicine, Richmond, VA, USA.
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Al Shabeeb R, Safadi AL, Trevisan C, Singaraju R. Gastrointestinal Symptoms and Lactic Acidosis in a Chronic Marijuana User. Fed Pract 2021; 38:e29-e31. [PMID: 34177226 DOI: 10.12788/fp.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A patient presented with diffuse abdominal pain and a history of frequent cannabis use, a diet lacking in meat and fish, and an increase in consumption of simple carbohydrates in the past year.
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Affiliation(s)
- Reem Al Shabeeb
- is a Medical Student at the School of Medicine and Health Sciences at George Washington University. is a Rheumatology Fellow and is a Neurology Resident in the Departments of Internal Medicine and Neurology, both at MedStar Georgetown University Hospital, all in Washington, DC. is an Assistant Professor in the Department of Medicine at the Uniformed Services University of the Health Sciences in Bethesda, Maryland
| | - Amy Li Safadi
- is a Medical Student at the School of Medicine and Health Sciences at George Washington University. is a Rheumatology Fellow and is a Neurology Resident in the Departments of Internal Medicine and Neurology, both at MedStar Georgetown University Hospital, all in Washington, DC. is an Assistant Professor in the Department of Medicine at the Uniformed Services University of the Health Sciences in Bethesda, Maryland
| | - Caroline Trevisan
- is a Medical Student at the School of Medicine and Health Sciences at George Washington University. is a Rheumatology Fellow and is a Neurology Resident in the Departments of Internal Medicine and Neurology, both at MedStar Georgetown University Hospital, all in Washington, DC. is an Assistant Professor in the Department of Medicine at the Uniformed Services University of the Health Sciences in Bethesda, Maryland
| | - Raj Singaraju
- is a Medical Student at the School of Medicine and Health Sciences at George Washington University. is a Rheumatology Fellow and is a Neurology Resident in the Departments of Internal Medicine and Neurology, both at MedStar Georgetown University Hospital, all in Washington, DC. is an Assistant Professor in the Department of Medicine at the Uniformed Services University of the Health Sciences in Bethesda, Maryland
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Mates E, Alluri D, Artis T, Riddle MS. A Retrospective Case Series of Thiamine Deficiency in Non-Alcoholic Hospitalized Veterans: An Important Cause of Delirium and Falling? J Clin Med 2021; 10:jcm10071449. [PMID: 33916273 PMCID: PMC8037750 DOI: 10.3390/jcm10071449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/19/2022] Open
Abstract
Thiamine deficiency (TD) in non-alcoholic hospitalized patients causes a variety of non-specific symptoms. Studies suggest it is not rare in acutely and chronically ill individuals in high income countries and is underdiagnosed. Our aim is to demonstrate data which help define the risk factors and constellation of symptoms of TD in this population. We describe 36 cases of TD in hospitalized non-alcoholic veterans over 5 years. Clinical and laboratory data were extracted by chart review +/− 4 weeks of plasma thiamine level 7 nmol/L or less. Ninety-seven percent had two or more chronic inflammatory conditions (CICs) and 83% had one or more acute inflammatory conditions (AICs). Of possible etiologies of TD 97% had two or more of: insufficient intake, inflammatory stress, or increased losses. Seventy-five percent experienced 5% or more weight loss. Ninety-two percent had symptoms with the most common being weakness or falling (75%) followed by neuropsychiatric manifestations (72%), gastrointestinal dysfunction (53%), and ataxia (42%). We conclude that TD is underdiagnosed in this population with consequent morbidity and mortality. TD likely develops because of inflammatory stress from CIC’s compounded by AIC’s combined with decreased energy intake or increased nutrient losses.
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Affiliation(s)
- Elisabeth Mates
- Medicine Department, Veterans Affairs Sierra Nevada Healthcare System, Reno, NV 89502, USA;
- School of Medicine, University of Nevada, Reno, NV 89502, USA;
- Correspondence:
| | - Deepti Alluri
- Sound Physicians, Lutheran Hospital, Fort Wayne, IN 46804, USA;
| | - Tailer Artis
- School of Medicine, University of Nevada, Reno, NV 89502, USA;
| | - Mark S. Riddle
- Medicine Department, Veterans Affairs Sierra Nevada Healthcare System, Reno, NV 89502, USA;
- School of Medicine, University of Nevada, Reno, NV 89502, USA;
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Raj KM, Baranwal AK, Attri SV, Jayashree M, Kumar-M P, Patial A, Saini AG. Thiamine Status in Children with Septic Shock from a Developing Country: A Prospective Case-Control Study. J Trop Pediatr 2021; 67:6056050. [PMID: 33381852 DOI: 10.1093/tropej/fmaa107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Mitochondrial dysfunction is central to sepsis-induced multi-organ dysfunction. Thiamine deficiency may contribute to mitochondrial dysfunction and thus high mortality. Study was planned to assess thiamine status in children with septic shock in comparison to healthy controls from a developing country and to study the effect of thiamine levels on its outcome. METHODS A prospective case-control study (April 2017 to May 2018) enrolling consecutive children with septic shock as 'cases' (n = 76), their healthy siblings (n = 51) and apparently healthy children from immunization clinic (n = 35) as 'controls'. Whole blood total thiamine (WBTT) level was measured on days 1, 10 and 1-month post-discharge. Outcome parameters were acute care area free days on days 14 and 28, and mortality. RESULTS WBTT [nMol/l; median (interquartile range, IQR)] was significantly lower on day 1 in cases compared with sibling controls [23.1 (21.8-26.3) vs. 36.9 (33.6-40.5); p < 0.001]. It fell further on day 10 [20.8 (18.1-21.1); p < 0.02]. Levels rose significantly 1-month post-discharge [35.5 (31.2-36.6)] and became comparable to sibling controls (p = 0.4). Immunization clinic controls also had lower WBTT [42.3 (40.1-45.9)], but was significantly higher than sibling controls and cases at 1-month post-discharge (p < 0.001). Survivors and non-survivors of septic shock were similar. WBTT levels did not correlate with any of the severity indicators of septic shock or its outcomes. CONCLUSIONS WBTT was significantly low in all children, and fell further during septic shock. Observed severe deficiency might have precluded any further association of thiamine levels with severity of septic shock and its outcome. Data obtained may inform trials on metabolic resuscitation in paediatric septic shock in developing countries. Lay summaryThiamine deficiency may contribute to high mortality in paediatric septic shock as thiamine is an essential factor for functioning of mitochondria, the powerhouse of the cells. This prospective case-control study was conducted to assess thiamine status in children with septic shock in comparison with healthy controls in a developing country. Consecutive children with fluid-refractory septic shock were enrolled as 'cases'. Their apparently healthy siblings, and apparently healthy children from immunization clinic, were enrolled as 'controls'. The whole blood total thiamine (WBTT) level was measured on days 1, 10 and 1 month after hospital discharge. Seventy-six children were enrolled as cases, 51 children as sibling controls and 35 children as immunization clinic controls. WBTT was significantly lower on day 1 in cases as compared with their sibling controls. It fell further on day 10. The level rose significantly after a month of discharge and became comparable to sibling controls. Immunization clinic controls also had lower WBTT but was significantly higher compared with sibling controls and cases at 1-month post-discharge. Survivors and non-survivors of septic shock had similar WBTT levels. Observed severe deficiency might have precluded any further association of thiamine levels with septic shock outcome.
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Affiliation(s)
- Kumar Manish Raj
- Division of Pediatric Critical Care, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun K Baranwal
- Division of Pediatric Critical Care, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Pediatric Biochemistry Unit, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muralidharan Jayashree
- Division of Pediatric Critical Care, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Patial
- Pediatric Biochemistry Unit, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi Gahlot Saini
- Division of Pediatric Neurology, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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A Systematic Review of the Role of Thiamine Supplementation in Treatment of Refeeding Syndrome. TOP CLIN NUTR 2021. [DOI: 10.1097/tin.0000000000000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bordia T, Zahr NM. The Inferior Colliculus in Alcoholism and Beyond. Front Syst Neurosci 2020; 14:606345. [PMID: 33362482 PMCID: PMC7759542 DOI: 10.3389/fnsys.2020.606345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/02/2020] [Indexed: 12/28/2022] Open
Abstract
Post-mortem neuropathological and in vivo neuroimaging methods have demonstrated the vulnerability of the inferior colliculus to the sequelae of thiamine deficiency as occurs in Wernicke-Korsakoff Syndrome (WKS). A rich literature in animal models ranging from mice to monkeys-including our neuroimaging studies in rats-has shown involvement of the inferior colliculi in the neural response to thiamine depletion, frequently accomplished with pyrithiamine, an inhibitor of thiamine metabolism. In uncomplicated alcoholism (i.e., absent diagnosable neurological concomitants), the literature citing involvement of the inferior colliculus is scarce, has nearly all been accomplished in preclinical models, and is predominately discussed in the context of ethanol withdrawal. Our recent work using novel, voxel-based analysis of structural Magnetic Resonance Imaging (MRI) has demonstrated significant, persistent shrinkage of the inferior colliculus using acute and chronic ethanol exposure paradigms in two strains of rats. We speculate that these consistent findings should be considered from the perspective of the inferior colliculi having a relatively high CNS metabolic rate. As such, they are especially vulnerable to hypoxic injury and may be provide a common anatomical link among a variety of disparate insults. An argument will be made that the inferior colliculi have functions, possibly related to auditory gating, necessary for awareness of the external environment. Multimodal imaging including diffusion methods to provide more accurate in vivo visualization and quantification of the inferior colliculi may clarify the roles of brain stem nuclei such as the inferior colliculi in alcoholism and other neuropathologies marked by altered metabolism.
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Affiliation(s)
- Tanuja Bordia
- Neuroscience Program, SRI International, Menlo Park, CA, United States
| | - Natalie M. Zahr
- Neuroscience Program, SRI International, Menlo Park, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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Uusalo P, Järvisalo MJ. Mortality and renal prognosis in isolated metformin-associated lactic acidosis treated with continuous renal replacement therapy and citrate-calcium-anticoagulation. Acta Anaesthesiol Scand 2020; 64:1305-1311. [PMID: 32564362 DOI: 10.1111/aas.13659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Use of metformin increases plasma lactate concentration and may lead to metformin-associated lactic acidosis (MALA). Previous studies have suggested severe MALA to have a mortality of 17%-21%, but have included patients with other coincident conditions such as sepsis. The treatment of choice is continuous renal replacement therapy (CRRT), which has been performed using heparin analogues or no anticoagulation in former studies. MATERIALS AND METHODS Patients admitted to the Intensive Care Unit of Turku University Hospital Finland with lactic acidosis without any other recognizable etiology than concomitant metformin treatment who required CRRT between years 2010 and 2019 were included. CRRT was performed using regional citrate-calcium-anticoagulation. Data extracted included patient demographics, comorbidities, and clinical parameters at 6-hour intervals about 72 hours from admission. Creatinine and estimated glomerular filtration rate (eGFR) were measured at 1 year after MALA. RESULTS A total of 23 patients with isolated MALA were included in the study. Median (IQR) pH was 6.88 (6.81-7.07) and lactate 16.1 (11.9-23.0) mmol/L on admission. Median (IQR) duration of CRRT was 62 (41-70) hours. Seven patients (30%) required mechanical ventilation with a mean duration of 6.0 ± 3.0 days. 90-day mortality was 4.3% and 1-year mortality 13.0%. Creatinine (P = .02) and eGFR (P = .03) remained significantly altered at 1 year of follow-up compared to baseline. CONCLUSIONS MALA can be treated effectively and safely with CRRT and citrate-calcium-anticoagulation, usually required for 2-3 days. Mortality of patients with MALA treated with CRRT is low when other conditions inducing lactic acidosis are excluded. MALA episode may be associated with long-lasting kidney injury.
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Affiliation(s)
- Panu Uusalo
- Department of Anaesthesiology and Intensive Care University of Turku Turku Finland
- Perioperative Services, Intensive Care and Pain Medicine Turku University Hospital Turku Finland
| | - Mikko J. Järvisalo
- Department of Anaesthesiology and Intensive Care University of Turku Turku Finland
- Perioperative Services, Intensive Care and Pain Medicine Turku University Hospital Turku Finland
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Miyamoto Y, Aso S, Iwagami M, Yasunaga H, Matsui H, Fushimi K, Hamasaki Y, Nangaku M, Doi K. Association Between IV Thiamine and Mortality in Patients With Septic Shock: A Nationwide Observational Study. Crit Care Med 2020; 48:1135-1139. [PMID: 32697483 DOI: 10.1097/ccm.0000000000004394] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To examine the effect of thiamine administration on mortality in patients with septic shock requiring norepinephrine. DESIGN Retrospective observational cohort study from July 2010 to March 2017. SETTING More than 1,000 acute care hospitals covering approximately 90% of all tertiary care emergency hospitals in Japan. PATIENTS Patients with septic shock requiring norepinephrine within 2 days of admission were retrospectively reviewed. INTERVENTIONS Patients who received greater than or equal to 100 mg of thiamine within 2 days of admission were included in the thiamine group and those who did not were included in the control group. MEASUREMENTS AND MAIN RESULTS We identified a total of 68,571 eligible patients, including 18,780 and 49,791 patients in the thiamine and control groups, respectively. In the thiamine group, 100 and 200 mg of thiamine per day were administered to 10,143 (54.0%) and 7,679 (40.9%) patients, respectively. The 28-day mortality were 19.2% (3,609/18,780) and 17.8% (8,845/49,791) in the thiamine and control groups, respectively. After adjusting for confounders by inverse probability of treatment weighting, no significant differences were observed between the two groups (risk difference, 0.2%; 95% CI, -0.5% to 0.9%). There were also no significant differences between the 100-mg thiamine group and the control group (risk difference, 0.6%; 95% CI, -0.3% to 1.4%) or between the 200-mg thiamine group and the control group (risk difference, -0.3%; 95% CI, -1.3% to 0.8%). CONCLUSIONS The findings of this nationwide database-based observational study did not support an association between thiamine administration early after admission and the 28-day mortality in patients with septic shock.
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Affiliation(s)
- Yoshihisa Miyamoto
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Shotaro Aso
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masao Iwagami
- Health Services Research and Development Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Health Services Research, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Yoshifumi Hamasaki
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kent Doi
- Department of Acute Care Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
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Didisheim C, Ballhausen D, Choucair ML, Longchamp D, Natterer J, Ferry T, Perez MH, Amiet V. Severe Lactic Acidosis in a Critically Ill Child: Think About Thiamine! A Case Report. J Pediatr Intensive Care 2020; 10:307-310. [PMID: 34745706 DOI: 10.1055/s-0040-1713382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/14/2020] [Indexed: 10/23/2022] Open
Abstract
In this article, we presented a teenager, in maintenance chemotherapy for leukemia, who was admitted for digestive symptoms related to a parasitic infection and required nutritional support with parenteral nutrition. After 6 weeks, his condition worsened with refractory shock of presumed septic origin, necessitating extracorporeal membrane oxygenation. Despite hemodynamic stabilization, his lactic acidosis worsened until thiamine supplementation was started. Lactate normalized within 12 hours. Thiamine is an essential coenzyme in aerobic glycolysis, and deficiency leads to lactate accumulation through anaerobic glycolysis. Thiamine deficiency is uncommon in the pediatric population. However, it should be considered in patients at risk of nutritional deficiencies with lactic acidosis of unknown origin.
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Affiliation(s)
- Clémence Didisheim
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Diana Ballhausen
- Department of Metabolic Disease, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Marie-Louise Choucair
- Department of Pediatrics, Pediatric Hematology Oncology Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - David Longchamp
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Julia Natterer
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Thomas Ferry
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Marie-Hélène Perez
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Vivianne Amiet
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
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Yoo JW, Kim RB, Ju S, Lee SJ, Cho YJ, Jeong YY, Lee JD, Kim HC. Clinical Impact of Supplementation of Vitamins B1 and C on Patients with Sepsis-Related Acute Respiratory Distress Syndrome. Tuberc Respir Dis (Seoul) 2020; 83:248-254. [PMID: 32539309 PMCID: PMC7362748 DOI: 10.4046/trd.2020.0008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/13/2020] [Indexed: 12/29/2022] Open
Abstract
Background Although few studies have reported improved clinical outcomes with the administration of vitamin B1 and C in critically ill patients with septic shock or severe pneumonia, its clinical impact on patients with sepsis-related acute respiratory distress syndrome (ARDS) remains unclear. The purpose of this study was to evaluate the association with vitamin B and C supplementation and clinical outcomes in patients with ARDS. Methods Patients with ARDS requiring invasive mechanical ventilation, admitted to the medical intensive care unit (ICU) were included in this study. Clinical outcomes were compared between patients administered with vitamin B1 (200 mg/day) and C (2 g/day) June 2018–May 2019 (the supplementation group) and those who did not receive vitamin B1 and C administration June 2017–May 2018 (the control group). Results Seventy-nine patients were included. Thirty-three patients received vitamin B1 and C whereas 46 patients did not. Steroid administration was more frequent in patients receiving vitamin B1 and C supplementation than in those without it. There were no significant differences in the mortality between the patients who received vitamin B1 and C and those who did not. There were not significant differences in ventilator and ICU-free days between each of the 21 matched patients. Conclusion Vitamin B1 and C supplementation was not associated with reduced mortality rates, and ventilator and ICU-free days in patients with sepsis-related ARDS requiring invasive mechanical ventilation.
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Affiliation(s)
- Jung-Wan Yoo
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Rock Bum Kim
- Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju, Korea
| | - Sunmi Ju
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Seung Jun Lee
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea.,Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yu Ji Cho
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea.,Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yi Yeong Jeong
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea.,Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jong Deog Lee
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea.,Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ho Cheol Kim
- Gyeongsang National University School of Medicine, Jinju, Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
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Obi J, Pastores SM, Ramanathan LV, Yang J, Halpern NA. Treating sepsis with vitamin C, thiamine, and hydrocortisone: Exploring the quest for the magic elixir. J Crit Care 2020; 57:231-239. [PMID: 32061462 PMCID: PMC8254386 DOI: 10.1016/j.jcrc.2019.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/28/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
Abstract
The administration of ascorbic acid (vitamin C) alone or in combination with thiamine (vitamin B1) and corticosteroids (VCTS) has recently been hypothesized to improve hemodynamics, end-organ function, and may even increase survival in critically ill patients. There are several clinical studies that have investigated the use of vitamin C alone or VCTS in patients with sepsis and septic shock or are ongoing. Some of these studies have demonstrated its safety and potential benefit in septic patients. However, many questions remain regarding the optimal dosing regimens and plasma concentrations, timing of administration, and adverse effects of vitamin C and thiamine. These questions exist because the bulk of research regarding the efficacy of vitamin C alone or in combination with thiamine and corticosteroids in sepsis is limited to a few randomized controlled trials, retrospective before-and-after studies, and case reports. Thus, although the underlying rationale and mechanistic pathways of vitamin C and thiamine in sepsis have been well described, the clinical impact of the VCTS regimen is complex and remains to be determined. This review aims to explore the current evidence and potential benefits and adverse effects of the VCTS regimen for the treatment of sepsis.
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Affiliation(s)
- J Obi
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - S M Pastores
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Weill Cornell Medical College, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | - L V Ramanathan
- Clinical Chemistry Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - J Yang
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - N A Halpern
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Weill Cornell Medical College, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
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Ehsanian R, Anderson S, Schneider B, Kennedy D, Mansourian V. Prevalence of Low Plasma Vitamin B1 in the Stroke Population Admitted to Acute Inpatient Rehabilitation. Nutrients 2020; 12:nu12041034. [PMID: 32290066 PMCID: PMC7230706 DOI: 10.3390/nu12041034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine the prevalence of vitamin B1 (VitB1) deficiency in the stroke population admitted to acute inpatient rehabilitation. DESIGN Retrospective cohort study. SETTING Acute inpatient rehabilitation facility at an academic medical center. PARTICIPANTS 119 consecutive stroke patients admitted to stroke service from 1 January 2018 to 31 December 2018. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Plasma VitB1 level. RESULTS There were 17 patients (14%; 95% CI 9-22%) with low VitB1 with a range of 2-3 nmol/L, an additional 58 (49%; CI 40-58%) patients had normal low VitB1 with a range of 4-9 nmol/L, twenty-five patients (21%; CI 15-29%) had normal high VitB1 with a range of 10-15 nmol/L, and nineteen patients (16%; CI 10-24%) had high VitB1 with a range of 16-43 nmol/L. CONCLUSIONS In this cohort of patients admitted to the stroke service at an acute rehabilitation facility, there is evidence of thiamine deficiency. Moreover, the data suggest that there is inadequate acute intake of VitB1. Given the role of thiamine deficiency in neurologic function, further study of the role of thiamine optimization in the acute stroke rehabilitation population is warranted.
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Affiliation(s)
- Reza Ehsanian
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
- Department of Neurosurgery, Stanford University, Palo Alto, CA 34304, USA
- Division of Physical Medicine and Rehabilitation, Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Sean Anderson
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
| | - Byron Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
| | - David Kennedy
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
| | - Vartgez Mansourian
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
- Correspondence: ; Tel.: +615-936-7708
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Abstract
Thiamine (vitamin B1) is a water-soluble vitamin essential for human health. Thiamine deficiency is causal and/or contributory in a number of debilitating diseases including beri-beri, the Wernicke-Korsakoff syndrome, optic neuropathy, and others. While thiamine deficiency is relatively rare in developed nations as a result of dietary supplementation, thiamine deficiency is more common in nutritionally compromised populations. Thiamine pyrophosphate, a thiamine derivative, is essential to the citric acid cycle and thiamine deficiency can result in impaired aerobic respiration and cellular energy production. Thiamine also plays an important role in the pentose phosphate pathway and other key metabolic processes. Although thiamine deficiency is a known cause of lactic acidosis, it has been recently evaluated as a potential contributor to refractory lactic acidosis and organ injury in septic shock and other shock states. In this article, we review the epidemiology of thiamine deficiency in septic shock and the existing evidence base supporting thiamine supplementation. We conclude that specific sepsis phenotypes may stand to benefit the most from thiamine supplementation, and efforts might be made to identify and supplement these patients early in their hospital course.
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Affiliation(s)
- Ari Moskowitz
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael W Donnino
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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66
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Vora B, Green EAE, Khuri N, Ballgren F, Sirota M, Giacomini KM. Drug-nutrient interactions: discovering prescription drug inhibitors of the thiamine transporter ThTR-2 (SLC19A3). Am J Clin Nutr 2020; 111:110-121. [PMID: 31764942 PMCID: PMC6944527 DOI: 10.1093/ajcn/nqz255] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/11/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Transporter-mediated drug-nutrient interactions have the potential to cause serious adverse events. However, unlike drug-drug interactions, these drug-nutrient interactions receive little attention during drug development. The clinical importance of drug-nutrient interactions was highlighted when a phase III clinical trial was terminated due to severe adverse events resulting from potent inhibition of thiamine transporter 2 (ThTR-2; SLC19A3). OBJECTIVE In this study, we tested the hypothesis that therapeutic drugs inhibit the intestinal thiamine transporter ThTR-2, which may lead to thiamine deficiency. METHODS For this exploration, we took a multifaceted approach, starting with a high-throughput in vitro primary screen to identify inhibitors, building in silico models to characterize inhibitors, and leveraging real-world data from electronic health records to begin to understand the clinical relevance of these inhibitors. RESULTS Our high-throughput screen of 1360 compounds, including many clinically used drugs, identified 146 potential inhibitors at 200 μM. Inhibition kinetics were determined for 28 drugs with half-maximal inhibitory concentration (IC50) values ranging from 1.03 μM to >1 mM. Several oral drugs, including metformin, were predicted to have intestinal concentrations that may result in ThTR-2-mediated drug-nutrient interactions. Complementary analysis using electronic health records suggested that thiamine laboratory values are reduced in individuals receiving prescription drugs found to significantly inhibit ThTR-2, particularly in vulnerable populations (e.g., individuals with alcoholism). CONCLUSIONS Our comprehensive analysis of prescription drugs suggests that several marketed drugs inhibit ThTR-2, which may contribute to thiamine deficiency, especially in at-risk populations.
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Affiliation(s)
- Bianca Vora
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth A E Green
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Natalia Khuri
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Frida Ballgren
- Department of Pharmaceutical Biosciences, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Kathleen M Giacomini
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
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Abstract
Every year, sepsis affects nearly 30 million people worldwide, with current annual estimates reporting as many as 6 million deaths. To combat the staggering number of patients who are affected by sepsis, clinicians continue to investigate novel treatment approaches. One treatment approach that has gained interest is the role that vitamins and nutrients play in the body's response to sepsis. Thiamine, in particular, has been studied because of its role in glucose metabolism and lactate production. This review provides a summary of the current literature surrounding the use of thiamine in the treatment of sepsis and describes the function of this essential nutrient in sepsis pathology. We also aim to provide clinicians with the necessary understanding to recognize the potential for thiamine deficiency, as well as detail the role of thiamine supplementation in the treatment of sepsis.
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Cvetinovic N, Loncar G, Isakovic AM, von Haehling S, Doehner W, Lainscak M, Farkas J. Micronutrient Depletion in Heart Failure: Common, Clinically Relevant and Treatable. Int J Mol Sci 2019; 20:E5627. [PMID: 31717934 PMCID: PMC6888526 DOI: 10.3390/ijms20225627] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 02/07/2023] Open
Abstract
Heart failure (HF) is a chronic condition with many imbalances, including nutritional issues. Next to sarcopenia and cachexia which are clinically evident, micronutrient deficiency is also present in HF. It is involved in HF pathophysiology and has prognostic implications. In general, most widely known micronutrients are depleted in HF, which is associated with symptoms and adverse outcomes. Nutritional intake is important but is not the only factor reducing the micronutrient availability for bodily processes, because absorption, distribution, and patient comorbidity may play a major role. In this context, interventional studies with parenteral micronutrient supplementation provide evidence that normalization of micronutrients is associated with improvement in physical performance and quality of life. Outcome studies are underway and should be reported in the following years.
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Affiliation(s)
- Natasa Cvetinovic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic—Dedinje”, 11000 Belgrade, Serbia;
| | - Goran Loncar
- Institute for Cardiovascular Diseases Dedinje, 11000 Belgrade, Serbia;
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Goettingen Medical Center, DE-37075 Goettingen, Germany;
- German Center for Cardiovascular Research (DZHK), partner site Goettingen, DE-37099 Goettingen, Germany
| | - Wolfram Doehner
- Berlin Institute of Health Center for Regenerative Therapies (BCRT) and Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, DE-13353 Berlin, Germany;
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, SI-9000 Murska Sobota, Slovenia
- Faculty of Medicine, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Jerneja Farkas
- Research Unit, General Hospital Murska Sobota, SI-9000 Murska Sobota, Slovenia
- National Institute of Public Health, SI-1000 Ljubljana, Slovenia
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Lee JJ, Mater S, Morillo-Hernandez C, Patton T, Huen AC, Ho J, English JC. Clinical Outcomes of Hospitalized Adult Patients With Dermatologic Manifestations of Protein Malnutrition and Zinc Deficiency. JAMA Dermatol 2019; 155:975-977. [PMID: 31188404 DOI: 10.1001/jamadermatol.2019.0854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jonathan J Lee
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sara Mater
- currently a medical student at University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Carlos Morillo-Hernandez
- currently a medical student at University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Timothy Patton
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arthur C Huen
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jonhan Ho
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joseph C English
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Sadaka F, Grady J, Organti N, Donepudi B, Korobey M, Tannehill D, O'Brien J. Ascorbic Acid, Thiamine, and Steroids in Septic Shock: Propensity Matched Analysis. J Intensive Care Med 2019; 35:1302-1306. [PMID: 31315499 DOI: 10.1177/0885066619864541] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION We aimed to study the use of ascorbic acid, thiamine, and steroids (ATS) in patients with septic shock (SS). METHODS Data on 62 patients with SS were collected from Acute Physiologic and Chronic Health Evaluation (APACHE) Outcome database and medical records. The ATS group received full doses of intravenous (IV) ATS (ascorbic acid [1.5 g every 6 hours for 4 days], hydrocortisone [50 mg every 6 hours for 7 days], and thiamine [200 mg every 12 hours for 4 days]). Data included age, gender, APACHE III, acute physiologic score (APS), mechanical ventilation (MV), lactic acid (LA), serum creatinine (Cr), duration of vasopressors (VP, days, median: interquartile ranges [IQR]: [Q1, Q3]), MV-free days (median: IQR [Q1-Q3]), percentage of patients requiring renal replacement therapy (RRT) for acute kidney injury (AKI), and mortality. Propensity analysis was used to match patients on age, gender, MV, APACHE III, APS, LA, and Cr. RESULTS The ATS group had longer duration of VP (4.5: 4.0-6.0 vs 2.0: 1.0-2.0, P = .001), similar RRT for AKI (26% vs 29%, P = .8), similar MV-free days (10.2: 5.0-15.0 vs 10.2: 1.6-18.0, P > .9), lower intensive care unit mortality (9.6% vs 42%, P = .004), and a trend toward lower hospital mortality (29% vs 45%, P = .2) compared to the NO ATS group. CONCLUSIONS The use of IV ascorbic acid, thiamine, and hydrocortisone might be beneficial in patients with SS.
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Affiliation(s)
- Farid Sadaka
- 24116Mercy Hospital St Louis/St. Louis University, St. Louis, MO, USA
| | - Justin Grady
- 24116Mercy Hospital St Louis/St. Louis University, St. Louis, MO, USA
| | - Nikhil Organti
- 24116Mercy Hospital St Louis/St. Louis University, St. Louis, MO, USA
| | - Bhargavi Donepudi
- 24116Mercy Hospital St Louis/St. Louis University, St. Louis, MO, USA
| | - Matthew Korobey
- 24116Mercy Hospital St Louis/St. Louis University, St. Louis, MO, USA
| | - David Tannehill
- 24116Mercy Hospital St Louis/St. Louis University, St. Louis, MO, USA
| | - Jacklyn O'Brien
- 24116Mercy Hospital St Louis/St. Louis University, St. Louis, MO, USA
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Atypical presentation of a forgotten disease: refractory hypotension in beriberi. Eur J Clin Nutr 2019; 73:1598-1600. [PMID: 31285553 DOI: 10.1038/s41430-019-0469-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Thiamine deficiency is a treatable disease with an excellent prognosis. However, it is often unrecognized because of the diversity of its clinical presentations. SUBJECTS/METHODS Herein, we report two atypical cases of nonalcoholic thiamine deficiency that presented with refractory hypotension in the absence of lactic acidosis. RESULTS Case 1 developed recurrent hypotension, right-sided heart failure, and a classic triad of Wernicke's encephalopathy (WE) after gastrointestinal surgery. Case 2 had decreased dietary intake and diuretic abuse, and had multiple episodes of syncope prior to present admission with refractory hypotension and mental status changes. The diagnosis of both cases was confirmed by undetectable pretreatment serum thiamine and dramatic improvement with thiamine replacement. CONCLUSIONS In this report, we highlight refractory hypotension as a complication of, not only cardiovascular, but also neurologic beriberi. Moreover, thiamine replacement should be considered without delay in hypotensive patients with signs of WE and/or risk factors for beriberi.
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Mohamed RAE, Abu Farag IM, Elhady M, Ibrahim RS. Myocardial dysfunction in relation to serum thiamine levels in children with diabetic ketoacidosis. J Pediatr Endocrinol Metab 2019; 32:335-340. [PMID: 30862760 DOI: 10.1515/jpem-2018-0320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 02/08/2019] [Indexed: 02/07/2023]
Abstract
Background Thiamine deficiency is commonly reported in patients with diabetes especially during diabetic ketoacidosis (DKA) that could attribute to myocardial dysfunction in those patients. However, there is limited data regarding its relation to myocardial function among those patients. This study aimed to explore the association between myocardial function and serum thiamine levels in children with type 1 diabetes mellitus (DM). Methods This cross-sectional comparative study included 25 patients with DKA. Clinical data assessment, echocardiographic examination and measurement of serum high-sensitive troponin T (hs-cTnT) and thiamine levels were done. We also assessed the association between troponin levels, echocardiographic ventricular systolic and diastolic function and serum thiamine. Results Twenty-four percent of children with DKA had thiamine deficiency. DKA children with thiamine deficiency had significant acidosis and higher serum troponin levels and significant impairment of diastolic function than those without thiamine deficiency. The serum thiamine level had a significant positive correlation with the echocardiographic indices of diastolic function but negative correlation with troponin levels. Conclusions Thiamine deficiency is a common finding during the treatment of children with DKA, and this deficiency may be associated with myocardial dysfunction.
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Affiliation(s)
| | | | - Marwa Elhady
- Pediatric Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Radwa Saeed Ibrahim
- Clinical Pathology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
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