An increased prevalence of thiamine deficiency has been described in diabetic outpatients. While acute thiamine deficiency can contribute to lactic acidosis (e.g., BeriBeri), this phenomenon has not been studied in relation to diabetic ketoacidosis (DKA).
We hypothesize that thiamine deficiency is associated with higher lactic acid levels in patients with DKA.
This was a cross-sectional study of patients presenting to an urban tertiary care center with a diagnosis of DKA between November 2009 and June 2012. Inclusion criteria consisted of adult patients, serum glucose >250 mg/dL, bicarbonate? 20 mEg/L, anion gap >16 mEg/L, pH <7.30, and the presence of urine ketones. Patients with competing causes of lactic acidosis, ongoing thiamine supplementation or pregnancy were excluded. Data were collected prospectively. A blood draw was performed at enrollment and the blood sample was analyzed for serum thiamine and lactate levels.??Thiamine and lactate levels were converted logarithmically? due to non-normality of the data.?? Linear regression was used to evaluate the relationship between thiamine deficiency and lactate??. All analysis was performed using JMP Pro, a component of SAS (Cary, NC).
Thirty-two DKA patients were included in the study. The median age was 42 and 38% were male. The median thiamine level was 14 nmol/L (IQR 8.5-18) and eight patients (25%) were found to have absolute thiamine deficiency with levels < 9 nmol/L.?Twelve patients (38%) identified as African-American and, of those, 6 (50%) had an absolute thiamine deficiency.??The median lactate levels in the thiamine deficient and sufficient groups were 5.8 (IQR 2.1-7.7) and 2.1 (1.1-3.7) respectively (p = 0.005). A statistically significant inverse association between lactic acid levels and blood thiamine levels was found (r2=0.244, p=0.009). This relationship remained significant after adjustment for severity of illness using the APACHE II score (r2=0.25, p=0.04).
Thiamine deficiency is associated with higher lactate levels in patients presenting with DKA. Study of thiamine supplementation in DKA is warranted.
Beth Israel Deaconess Medical Center