Thiamine responsive lactic acidosis in patients not in shock: A case series and literature review

Document Type

Article

Publication Date

8-2026

Institution/Department

Internal Medicine

Journal Title

The American journal of the medical sciences

MeSH Headings

Humans; Acidosis, Lactic (drug therapy, etiology, blood); Thiamine (therapeutic use, administration & dosage); Thiamine Deficiency (drug therapy, complications); Female; Male; Middle Aged; Aged; Adult; Lactic Acid (blood); Shock

Abstract

Lactic acidosis is a common feature of patients presenting with sepsis, volume depletion due to ketoacidosis, tissue ischemia, shock and liver disease. These cases typically presume tissue hypoxia and anaerobic metabolism leading to lactic acidosis. Thiamine deficiency is an underappreciated cause of type B lactic acidosis, which is not caused by anaerobic metabolism. We present a case series of 11 patients admitted to the medicine service who were not in shock, and who had a lactic acidosis (average of 4.5 mmol/L) that improved after thiamine administration (resolving to < 2 mmol/L in 10 of 11 patients). We then review thiamine and lactate physiology, and provide clinicians with evidence based recommendations to consider when treating patients with persistent lactic acidosis who are vitally stable.

First Page

164

Last Page

170

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