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Rapid reversal of severe lactic acidosis after thiamine administration in critically ill adults: a r

Gondwanaland

Senior Member
Messages
5,092
Nutr Clin Pract. 2015 Feb;30(1):104-10. doi: 10.1177/0884533614561790. Epub 2014 Dec 16.
Rapid reversal of severe lactic acidosis after thiamine administration in critically ill adults: a report of 3 cases.
Giacalone M1, Martinelli R2, Abramo A2, Rubino A3, Pavoni V4, Iacconi P5, Giunta F6, Forfori F6.
Author information
  • 1Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy marilugiacalone@gmail.com.
  • 2Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
  • 3Papworth Hospital NHS Foundation Trust, Papworth Everard, UK.
  • 4Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
  • 5University of Pisa, Pisa, Italy.
  • 6Department of Anesthesia and Intensive Care, University of Pisa, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
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.

© 2014 American Society for Parenteral and Enteral Nutrition.
 

mgk

Senior Member
Messages
155
Also interesting that thiamine is one of the main components of the so-called "Banana Bag":
A banana bag (or rally pack) is a bag of IV fluids containing vitamins and minerals. The bags typically contain thiamine, folic acid, and 3 grams of magnesium sulfate, and are usually used to replenish nutritional deficiencies or correct a chemical imbalance in the human body. The multi-vitamin solution has a yellow color, hence the term "banana bag".

Banana bags are used in the Intensive Care Unit to correct acute magnesium deficiencies. They are stated to be beneficial for patients with terminal illness because magnesium can mitigate nerve pain and relieve muscle pain and cramps.

Rally packs or Banana Bags are most often used for alcoholics who need thiamine to prevent Wernicke-Korsakoff syndrome. Chronic alcoholics can suffer significant whole-body magnesium deficiencies.
 
Messages
56
this is an interesting topic that i feel needs to be looked into. does this mean that people who have trouble getting rid of excess lactic acid may be deficient in vitamin B1?
 

Gondwanaland

Senior Member
Messages
5,092
this is an interesting topic that i feel needs to be looked into. does this mean that people who have trouble getting rid of excess lactic acid may be deficient in vitamin B1?
Yes but keep in mind that
http://www.acu-cell.com/bx.html
An individual who is prone for gout might need more pantothenic acid (Vitamin B5) but less lecithin, while anyone with a tendency for iron overload would need less Vitamin B1, but much more Vitamin B2. Some of those suffering from hypoadrenalism (Addison's disease) would benefit from extra Vitamin B1 and/or choline for their sodium-raising properties, while sodium-sensitive individuals or anyone with a tendency for hyper-adrenalism (Cushing's disease) might benefit from extra Vitamin B2 and folic acid, which have a sodium-lowering effect.
 

helen1

Senior Member
Messages
1,033
Location
Canada
Geez. Folate and B2 lower sodium? And here I am constantly trying to keep fluids in my body while taking folate and B2. Oh right it's the acu-cell website that makes my head spin.
 

junkcrap50

Senior Member
Messages
1,321
I've found Thiamine critical to my health (and in conjunction with the DQ). I take three kinds: thiamine, benfotiamine, and sulbutiamine.

@silverseas2014, may I ask how much total thiamine (sum of all forms) you take? And what kind of symptoms you tended to have when you were low on B1, before supplementing resolved it? I am finding I need B1 too to help with Freddd's DQ and am curious.
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
Geez. Folate and B2 lower sodium? And here I am constantly trying to keep fluids in my body while taking folate and B2. Oh right it's the acu-cell website that makes my head spin.
I am sometimes having trouble keeping fluids in my body but am taking 12.5 mg thiamine (833%) and 400 mcg folate (100%) (among other things). It doesn't seem to be helping.

I suspect that it is due to an imbalance in thyroid hormones.

As I am having trouble thinking, I can't guarantee that I will be able to answer questions on this (at least at present).
 
Messages
76
Location
Southwest
@silverseas2014, may I ask how much total thiamine (sum of all forms) you take? And what kind of symptoms you tended to have when you were low on B1, before supplementing resolved it? I am finding I need B1 too to help with Freddd's DQ and am curious.

Hi @junkcrap50 .... I have just returned from holiday, and saw your questions.

I take:
Sulbutiamine: 200 mg/day (Brand: NeuroFlow)
Benfotiamine: 150 mg/day (Doctor's Best)
High Potency B-1 (Thiamine): about 125 mg/day (Source Naturals)

--Just recently, I have decided to cycle Sulbutiamine as I think it is contributing to daily headaches.
--Symptoms I believe that were partially remediated by taking thiamine: fatigue, irritability, pain.... the relief of muscle aches and pains were remarkably diminished by Benfotiamine (it functions almost like an NSAID).... I have been taking Thiamine for about 3 years now.... and will have to dig through my logs to find more comments/thoughts
--I have taken much higher doses of both the Benfotiamine and the High Potency B-1, but they revved up my methylation... and I am now at the doses listed above.

Cheers,
Silverseas2014
 

junkcrap50

Senior Member
Messages
1,321
Hi @junkcrap50 .... I have just returned from holiday, and saw your questions.

I take:
Sulbutiamine: 200 mg/day (Brand: NeuroFlow)
Benfotiamine: 150 mg/day (Doctor's Best)
High Potency B-1 (Thiamine): about 125 mg/day (Source Naturals)

--Just recently, I have decided to cycle Sulbutiamine as I think it is contributing to daily headaches.
--Symptoms I believe that were partially remediated by taking thiamine: fatigue, irritability, pain.... the relief of muscle aches and pains were remarkably diminished by Benfotiamine (it functions almost like an NSAID).... I have been taking Thiamine for about 3 years now.... and will have to dig through my logs to find more comments/thoughts
--I have taken much higher doses of both the Benfotiamine and the High Potency B-1, but they revved up my methylation... and I am now at the doses listed above.

Cheers,
Silverseas2014

Thanks very much for replying. I found similar symptoms resolved with benfotiamine. No need to dig into more comments. I've been taking just 150 benfotiamine and occassionaly some Source Naturals sublingual thiamine.

You should research the side effects of sulbutiamine. On many nootropic sites and forums, I believe reading many people have experienced dependency and tolerance build-up fairly quickly on sulbutiamine. The nootropic geeks seem to be very wary of it. Just FYI.