Severe metabolic acidosis and heart failure due to thiamine deficiency

Comparison of Nutritional Composition and Antioxidant Properties of Pulverized and Unutilized Portions of Waxy Barley

To promote the use of waxy barley bran, an underutilized resource, samples of waxy barley were divided into three parts: polished waxy barley powder (PWBP), inner bran layer powder (IBLP), and outer bran layer powder (OBLP). The color and appearance, general properties, minerals, vitamins, β-glucan, antioxidant properties, and aroma of each part were compared. In terms of appearance and color, IBLP and OBLP appeared more yellow than PWBP; general components that were more abundant in IBLP and OBLP compared with PWBP were protein, fat, and ash. IBLP and OBLP had characteristically high values of Mg and Zn, monounsaturated and polyunsaturated fatty acids, vitamin B₁, total polyphenol content, H-ORAC, and DPPH. In particular, the vitamin B₁ content of OBLP was approximately 10 times higher than that of PWBP, and Mg and Zn content was more than five times higher than in PWBP. The β-glucan content of IBLP and OBLP was lower than that of PWBP, but relatively high. GC-MS analysis revealed that hexanal was the aroma component common to all three samples, and the peak areas were in the order of PWBP > OBLP > IBLP.

Wet beriberi with multiple organ failure remarkably reversed by thiamine administration: A case report and literature review

RATIONALE

Circulatory failure, especially with low systemic vascular resistance (SVR), as observed in septic shock, thyrotoxicosis, and anemia, is a particular pattern that should suggest thiamine (vitamin B1) deficiency. The clinical picture of wet beriberi secondary to thiamine deficiency only demonstrates non-specific clinical manifestations. For a diagnosis of wet beriberi, medical history is very important. Interestingly, imprisonment was also found to be related to thiamine deficiency. This article presents a rare case of wet beriberi associated with multiple organ failure (MOF) in a prison patient with years of heavy alcohol consumption.

PATIENT CONCERNS

The patient reported repetitive symptoms of nausea, vomiting, respiratory distress, and palpitations for a period of 1 month; dyspnea and edema for 5 days; and decreased blood pressure and urine volume for 2 days.

DIAGNOSES

The heart failure patient had a history of dietary deficiency. Right heart catheterization showed high cardiac output (CO) and low SVR. Measurement of serum thiamine concentration was low. The most important factor was that the hemodynamic indices were remarkably reversed by thiamine administration.

INTERVENTIONS

The patient started treatment with thiamine (100 mg) by intramuscular injection, together with basic supportive care.

OUTCOMES

The hemodynamic indices improved within 12 hours after thiamine administration. Echocardiographic examinations revealed right ventricular function improvement within a few days, which were normal within a month.

LESSONS

A diagnosis of wet beriberi should be considered for a prison patient who has unexplained heart failure, lactic acidosis, and/or MOF. Moreover, the patient should be empirically given thiamine administration without delay.

An unusual cause of persisting hyperlactatemia in a neonate undergoing open heart surgery

Being a reflection of the degree of global tissue anoxia, serum lactate levels therefore can be used as a marker of organ damage and eventual outcome. A statistically significant association was observed between serum lactate levels and subsequent mortality and morbidity in critically ill adults, children, and neonates. In cardiac critical care, hyperlactatemia is usually multifactorial in origin, resulting from a combination of etiologies. Many centers are using serial lactate levels in conjugation with other parameters of cellular oxygen delivery, consumption, or extraction to monitor prognosis after pediatric cardiac surgery. A single initial lactate level has a lesser predictive value for morbidity and mortality after pediatric cardiac surgery than its failure to fall within 48 hours of surgery. In case of persistently high lactate levels with no other evidence of cellular hypoperfusion, other possibilities must be considered. There has been an established association of lactic acidosis with thiamine deficiency, but this has not yet been reported in newborns undergoing congenital cardiac surgery. We present one such rare case.

Shoshin Beriberi in Critically-Ill patients: case series

Thiamine plays a fundamental role in cellular metabolism. The classical syndrome caused by thiamine deficiency is beriberi, and its fulminant variant, once considered an uncommon finding, is now encountered among the critically ill.

We present a case series of four critically ill non-septic non-alcoholic patients with severe lactic acidosis and refractory cardio-circulatory collapse caused by acute fulminant beriberi, which drastically responded to thiamine administration.

In critical care settings, increased awareness of this life-threatening but reversible condition is a requirement, especially among patients receiving parenteral nutrition and those with unexplained recalcitrant lactic acidosis.

Differential responses of B vitamins in black soybean seeds

This study was aimed to determine the contents and the association of B vitamins from seeds of 10 black and one yellow soybean (Glycine max (L.) Merr.) varieties with either green or yellow cotyledon. Thiamine, flavin adenine dinucleotide (FAD), riboflavin and total riboflavin were found highest in 'Chengjakong', while flavin mononucleotide (FMN) was greatest in 'Mirang'. Nicotinic acid and total vitamin B3 were highest in 'Shingi' as a yellow soybean variety but pantothenic acid and pyridoxine contents were greatest in 'Tawon' and 'Mirang', respectively. These content variations of B vitamins directly reflected the wide segregation of soybean varieties on the principal component analysis (PCA) scores plot, indicating that these 4 soybean varieties appeared to be least associated with other soybean varieties based on the different responses of B vitamins. The results of cluster and correlation analyses presented that the cotyledon colour of soybean seed contributed to a variation of B vitamin contents. Overall, the results suggest that a wide range of B vitamin contents would be affected by genotypic factors alongside the difference of cotyledon colour.

Thiamine in nutrition therapy

Clinicians involved with nutrition therapy traditionally concentrated on macronutrients and have generally neglected the importance of micronutrients, both vitamins and trace elements. Micronutrients, which work in unison, are important for fundamental biological processes and enzymatic reactions, and deficiencies may lead to disastrous consequences. This review concentrates on vitamin B(1), or thiamine. Alcoholism is not the only risk factor for thiamine deficiency, and thiamine deficiency is often not suspected in seemingly well-nourished or even overnourished patients. Deficiency of thiamine has historically been described as beriberi but may often be seen in current-day practice, manifesting as neurologic abnormalities, mental changes, congestive heart failure, unexplained metabolic acidosis, and so on. This review explains the importance of thiamine in nutrition therapy and offers practical tips on prevention and management of deficiency states.

[Shoshin beriberi: new emergence of an old pathology? About with 11 cases on island Mayotte]

In the French island of Mayotte in the Indian Ocean, the health and food situation remains contrasted. For a very long time dry beriberi women in postpartum had been suspected and treated. But in 2004 the first infantile epidemic of beriberi was scientifically authenticated and a program of thiaminic supplementation for the pregnant women and infants was set up. In this context, we describe an epidemic of 11 cases of shoshin beriberi among adults between January 2008 and Februar 2009. Over 11 cases of shoshin beriberi, 5 cases were confirmed biologically and 6 were probable. The sex ratio M/W was 0.37. The median age was 34 years. The clinic picture was typical: severe acute dyspnea, an agitation/drowsiness, right cardiac failure: polynevritis of the lower limbs was noted in 9 cases over 11. Biologically it was characterized by a lactic acidosis (average pH: 7.08, lactates: 12.08 mmol/l). The evolution was favorable in the 8 cases which could benefit from early thiaminic refill. The outbreak of an epidemic of shoshin beriberi among adults mainly in groups not having benefited from supplementation shows the effectiveness of the program but also its limits. We compare our series with others: the period from April to June when the food is less diversified, is confirmed as a higher risk period. The programs of nutritional education must be increased and a B1 vitamin supplementation for broader people during the rain season might be discussed.

Update on micronutrients in bariatric surgery

PURPOSE OF REVIEW

Obesity is a growing worldwide epidemic. Obese patients are often deficient in micronutrients despite macronutrient excess. Bariatric surgery is an increasingly utilized modality in the treatment of obesity and obesity-related conditions. Bariatric surgery itself may cause or exacerbate micronutrient deficiencies with serious sequelae. This review will focus on perioperative strategies to detect, prevent and treat micronutrient deficiencies in patients undergoing bariatric surgery, and will highlight practical and clinical aspects of these nutritional problems.

RECENT FINDINGS

Micronutrient deficiency is common in obese patients undergoing bariatric surgery both preoperatively and postoperatively. Bariatric procedures with a malabsorptive component are more likely to result in postoperative micronutrient deficiency. A system-based approach will facilitate clinical suspicion of specific or combined micronutrient deficiencies, leading to appropriate laboratory tests for confirmation. Supplementation by the oral route is always tried first, reserving parenteral administration for specific situations.

SUMMARY

Clinicians should be aware that micronutrient deficiencies are common in obese patients who may have macronutrient excess. Micronutrient deficiency may exist preoperatively or be caused by bariatric procedures themselves. A systematic and team-based approach will decrease morbidity associated with delays in diagnosis and treatment.

Cardiac structural changes and electrical remodeling in a thiamine-deficiency model in rats

AIMS

Thiamine is an important cofactor present in many biochemical reactions, and its deprivation can lead to heart dysfunction. Little is known about the influence of thiamine deprivation on the electrophysiological behavior of the isolated heart cells and information about thiamine deficiency in heart morphology is controversial. Thus, we decided to investigate the major repolarizing conductances and their influence in the action potential (AP) waveform as well as the changes in the heart structure in a set of thiamine deficiency in rats.

MAIN METHODS

Using the patch-clamp technique, we investigated inward (I(K1)) and outward K(+) currents (I(to)), T-type and L-type Ca(2+) currents and APs. To evaluate heart morphology we used hematoxylin and eosin in transversal heart sections.

KEY FINDINGS

Thiamine deficiency caused a marked decrease in left ventricle thickness, cardiomyocyte number, cell length and width, and membrane capacitance. When evaluating I(to) we did not find difference in current amplitude; however an acceleration of I(to) inactivation was observed. I(K1) showed a reduction in the amplitude and slope conductance, which implicated a less negative resting membrane potential in cardiac myocytes isolated from thiamine-deficient rats. We did not find any difference in L-type Ca(2+) current density. T-type Ca(2+) current was not observed. In addition, we did not observe significant changes in AP repolarization.

SIGNIFICANCE

Based on our study we can conclude that thiamine deficiency causes heart hypotrophy and not heart hypertrophy. Moreover, we provided evidence that there is no major electrical remodeling during thiamine deficiency, a feature of heart failure models.

Effect of Thiamine Pyrophosphate on Levels of Serum Lactate, Maximum Oxygen Consumption and Heart Rate in Athletes Performing Aerobic Activity

The aim of this study was to determine the effect of thiamine pyrophosphate (TPP) on serum lactate levels, maximum oxygen consumption (Vo2max) and heart rate in male athletes performing aerobic activity. A double-blind, randomized, crossover study was performed in which lactate levels, Vo2max and heart rates in 27 male athletes were compared at rest and after exercise, following administration of placebo (sodium chloride 0.9%) or TPP (1 mg/kg). At rest, serum lactate levels after placebo or TPP were similar; however, after exercise, the levels were lower in the athletes after taking TPP than after placebo. During exercise, Vo2max in athletes on TPP was higher than on placebo. At rest, heart rate after taking placebo or TPP was similar but, after exercise, heart rate was lower after taking TPP than after placebo. It is concluded that TPP caused serum lactate levels and heart rate to be lower than placebo and Vo2max to be higher in athletes performing aerobic physical activity.

Abolition of reperfusion-induced arrhythmias in hearts from thiamine-deficient rats

Extensive work has been done regarding the impact of thiamine deprivation on the nervous system. In cardiac tissue, chronic thiamine deficiency is described to cause changes in the myocardium that can be associated with arrhythmias. However, compared with the brain, very little is known about the effects of thiamine deficiency on the heart. Thus this study was undertaken to explore whether thiamine deprivation has a role in cardiac arrhythmogenesis. We examined hearts isolated from thiamine-deprived and control rats. We measured heart rate, diastolic and systolic tension, and contraction and relaxation rates. Whole cell voltage clamp was performed in rat isolated cardiac myocytes to measure L-type Ca2+current. In addition, we investigated the global intracellular calcium transients by using confocal microscopy in the line-scan mode. The hearts from thiamine-deficient rats did not degenerate into ventricular fibrillation during 30 min of reperfusion after 15 min of coronary occlusion. The antiarrhythmogenic effects were characterized by the arrhythmia severity index. Our results suggest that hearts from thiamine-deficient rats did not experience irreversible arrhythmias. There was no change in L-type Ca2+current density. Inactivation kinetics of this current in Ca2+-buffered cells was retarded in thiamine-deficient cardiac myocytes. The global Ca2+release was significantly reduced in thiamine-deficient cardiac myocytes. The amplitude of caffeine-releasable Ca2+was lower in thiamine-deficient myocytes. In summary, we have found that thiamine deprivation attenuates the incidence and severity of postischemic arrhythmias, possibly through a mechanism involving a decrease in global Ca2+release.

Fatal metabolic acidosis caused by thiamine deficiency

Acute thiamine deficiency, an uncommon cause of hemodynamic instability in Western countries, may be manifested by acute heart failure and neurological deficits. Severe metabolic acidosis is one of its least recognized features. We present a report of foreign workers who complained of weakness and lower limb edema and were found to have acute thiamine deficiency. One died of refractory metabolic acidosis and shock, and the diagnosis was reached post mortem. Thiamine deficiency should be considered in every case of severe lactic acidosis without an obvious cause, especially in high-risk populations (malnourished, alcoholics, Far-East workers, etc). Whenever it is suspected, empiric treatment with thiamine should be initiated immediately. Physicians who care for populations at risk should be familiar with the clinical spectrum of nutritional deficits, and monitor the nutritional habits of these patients carefully. The treatment is inexpensive and devoid of adverse effects. Moreover, delaying thiamine administration in patients with deficiency may cause severe life-threatening metabolic acidosis and affect recovery. The prophylactic use of thiamine in a high-risk population, even before blood levels are received, may be cost effective.

Effect of intravenous infusions of thiamine on the disposition kinetics of thiamine and its pyrophosphate

BACKGROUND

Thiamine supplementation is necessary in patients with thiamine deficiency syndromes. Experimental evidence suggests that tissue uptake and the elimination of thiamine are dose-dependent.

AIM

The aim of the present study was to investigate the effect of different i.v. infusion rates of thiamine on blood concentrations of thiamine and its active metabolite thiamine pyrophosphate (TPP) and on renal excretion of thiamine.

METHODS

Twelve healthy subjects received in a two-period block randomized study 150 mg thiamine intravenously over either 1 or 24 h.

RESULTS

The maximum blood concentrations (Cmax) of thiamine were significantly higher after the more rapid infusion (RI; 2300 ng/mL) than after the slower infusion (SI; 177 ng/mL). The AUC of thiamine was identical after both infusion protocols. There was a slightly (10%) increased AUC of TPP (P < 0.08) after SI, whereas C(max) values were comparable. Urinary excretion of thiamine was significantly decreased from 83.6% of the applied dose after RI to 57.6% after the SI.

CONCLUSIONS

Our data suggest an increased tissue uptake of thiamine when it is given as an SI compared with a RI of the same dose. It is concluded, therefore, that an SI of thiamine may be superior to RI or bolus injections to treat severe deficiency syndromes.