title: Rapid reversal of severe lactic acidosis after thiamine administration in critically ill adults: a report of 3 cases.
abstract: BACKGROUND
  Thiamine plays a critical role in energy metabolism. Critically ill patients may have thiamine deficiency and increased mortality due to potentially irreversible consequences. The aim of this study was to show the impact of thiamine deficiency in a series of patients and the rapid response to thiamine replacement, showing the changes in clinical and metabolic conditions over time.
  
  
  METHODS
  We described 3 cases of hospitalized patients who had received parenteral nutrition (PN) without vitamin supplementation. All the patients were admitted to the ICU between 2010 and 2011 with a severe form of lactic acidosis, an unstable circulatory state, and a different neurological disorder (a lethargic state, a severe form of impaired near-coma consciousness, and Wernicke encephalopathy).
  
  
  RESULTS
  Intravenous (IV) administration of thiamine was associated with a rapid and marked restoration of acid-base balance, hemodynamic stability and the disappearance of neurological disturbances, and normalization of the clinical and biochemical conditions of all the patients within the following hours.
  
  
  CONCLUSIONS
  The 3 cases demonstrated the rapidity of the reversal of severe thiamine deficiency, achieved by appropriate replacement in different hospitalized patients. The regression of clinical and biochemical disorders requires a prompt diagnosis and treatment based on the IV administration of thiamine and magnesium sulfate. In hospitalized patients at risk, thiamine deficiency is prevented by the integration of thiamine supplementation into PN and other forms of nutrition support.
authors.affiliation: Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy marilugiacalone@gmail.com.
authors.forename: Marilù
authors.initials: M
authors.lastname: Giacalone
authors.affiliation: Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Martinelli
authors.affiliation: Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Abramo
authors.affiliation: Papworth Hospital NHS Foundation Trust, Papworth Everard, UK.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rubino
authors.affiliation: Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Pavoni
authors.affiliation: University of Pisa, Pisa, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Iacconi
authors.affiliation: Department of Anesthesia and Intensive Care, University of Pisa, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Giunta
authors.affiliation: Department of Anesthesia and Intensive Care, University of Pisa, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Forfori
mesh_terms: D000140:Acidosis, Lactic / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006801:Humans; D009422:Nervous System Diseases / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D010288:Parenteral Nutrition / Q000009:adverse effects* / Q000379:methods; D012769:Shock / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D013831:Thiamine / Q000008:administration & dosage* / Q000627:therapeutic use*; D013832:Thiamine Deficiency / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D013831:Thiamine
keywords: critical illness; lactic acidosis; parenteral nutrition; thiamine; thiamine deficiency; thiamine pyrophosphate