title: The relationship between lactate and thiamine levels in patients with diabetic ketoacidosis.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: amoskowi@bidmc.harvard.edu.
authors.forename: Ari
authors.initials: A
authors.lastname: Moskowitz
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Graver
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Giberson
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Berg
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Xiaowen
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Amy
authors.initials: A
authors.lastname: Uber
authors.affiliation: Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Shiva
authors.initials: S
authors.lastname: Gautam
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
mesh_terms: D000140:Acidosis, Lactic / Q000453:epidemiology; D000328:Adult; D015897:Comorbidity; D016883:Diabetic Ketoacidosis / Q000097:blood* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013831:Thiamine / Q000097:blood*; D013832:Thiamine Deficiency / Q000453:epidemiology*
chemical_list: D019344:Lactic Acid; D013831:Thiamine
keywords: Diabetes mellitus; Diabetic ketoacidosis; Lactic acidosis; Thiamine; Thiamine deficiency