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Thiamine Therapy During Refractory Lactic Acidosis in Critically Ill Children.
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- Author(s): Kahveci, Fevzi; Fındık, İlker; Özen, Hasan; Coşkun, Mert Kaan; Uçmak, Hacer; Gurbanov, Anar; Balaban, Burak; Havan, Merve; Kendirli, Tanıl
- Source:
Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi; 2024, Vol. 11 Issue 2, p107-114, 8p- Subject Terms:
PEARSON correlation (Statistics); CRITICALLY ill; PATIENTS; HEMATOLOGIC malignancies; VITAMIN B1; FISHER exact test; TREATMENT effectiveness; RETROSPECTIVE studies; DESCRIPTIVE statistics; CHI-squared test; MANN Whitney U Test; LACTIC acidosis; LONGITUDINAL method; PEDIATRICS; VITAMIN B1 deficiency; MEDICAL records; ACQUISITION of data; INTENSIVE care units; LACTATES; DATA analysis software; CHILDREN; DISEASE complications - Source:
- Additional Information
- Alternate Title: Kritik Hasta Çocuklarda Dirençli Laktik Asidoz Sırasında Tiamin Tedavisi. (Turkish)
- Abstract: Introduction: Thiamin deficiency, which is an overlooked but important cause of lactic acidosis, can lead to several clinical symptoms, including neuropathy, cardiogenic shock, and death, even though it can be easily treated in critically ill children. Methods: A single-center, retrospective cohort study conducted between March 2020 and March 2022. Results: Twenty-two patients were included in the study. The mean age was 26.5 (range, 1-214) months. The median thiamin dose was 50 (range, 3-100) milligrams and the mean thiamin treatment duration was 4 (range, 1-16) days. The mean length of PICU when thiamin treatment was started was 8 (range, 2-177) days. Thiamin treatment was administered on the 2nd (1-5) day of lactic acidosis. The mean lactate values after thiamin treatment was 5.5 (range, 5-17) mmol/L at the 6th hour, 4.1 (range, 1.5-17) mmol/L at the 12th hour, 3.1 (1.4-20) mmol/L at the 24th hour, and 2.7 (range, 0.15-17) mmol/L at 48th hour. Eleven (50%) patients' lactate levels decreased below 4 mmol/L at the 12th hour of thiamin treatment. Blood gas values before thiamin treatment, lactate decrease trends, thiamin treatments' duration, and form, and patients' risk factors were not statistically significant in the two groups by 28-day mortality. Conclusion: We believe that in patients with lactic acidosis not directly related to a circulatory disorder, low clinical suspicion and early thiamin treatment of lactic acidosis is the right approach in the absence of specific diagnostic tests. [ABSTRACT FROM AUTHOR]
- Abstract: Giriş: Laktik asidozun gözden kaçan ancak önemli bir nedeni olan tiamin eksikliği, kritik hasta çocuklarda kolaylıkla tedavi edilebilmesine rağmen nöropati, kardiyojenik şok ve ölüm gibi çok çeşitli klinik spektrumlara yol açabilmektedir. Yöntemler: Mart 2020 ile Mart 2022 arasında tek merkezli, geriye dönük bir kohort çalışmasıdır. Bulgular: Yirmi iki hasta çalışmaya dahil edildi. Ortalama yaş 26,5 (1-214) aydı. Ortanca tiamin dozu 50 (3-100) miligram ve ortalama tiamin tedavi süresi 4 (1-16) gündü. Tiamin tedavisine başlandığında hastaların ortalama çocuk yoğun bakım ünite süresi 8 (2-177) gündü. Laktik asidozun 2. (1-5) gününde tiamin tedavisi başlandı. Tiamin tedavisi sonrası ortalama laktat değerleri 6. saatte 5,5 (5-17) mmol/L, 12. saatte 4,1 (1,5-17) mmol/L, 24. saatte 3,1 (1,4-20) mmol/L olarak ve 48. saatte 2,7 (aralık, 0,15-17) mmol/L olarak belirlendi. Tiamin tedavisinin 12. saatinde 11 (%50) hastanın laktat düzeyi 4 mmol/L'nin altına düştü. Tiamin tedavisi öncesi kan gazı değerleri, laktat düşüş eğilimleri, tiamin tedavilerinin süresi, şekli ve hasta risk faktörleri her iki grupta da 28 günlük mortalite açısından istatistiksel olarak anlamlı değildi. Sonuç: Dolaşım bozukluğu ile doğrudan ilişkili olmayan laktik asidozlu hastalarda, özgül tanı testlerinin yokluğunda düşük klinik şüphe ve laktik asidozun erken tiamin tedavisinin doğru yaklaşım olduğunu düşünüyoruz. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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