SHM Converge Scientific Abstract ePoster Gallery-Persistent Lactic Acidosis in the Setting of Malnutrition

Pdf Summary

This poster presents a 63-year-old man with hypertension and alcohol use disorder who came to the hospital with 2 weeks of black stools. He was hypothermic, hypotensive, tachycardic, and had melena, abdominal distension, and bilateral leg edema. Initial labs showed severe anemia, elevated lactate, and low albumin. Colonoscopy revealed marked friability suggestive of scurvy, and his vitamin C level was very low. Push enteroscopy identified a Dieulafoy’s lesion, which was cauterized, and his bleeding and hypotension resolved. However, his lactate remained elevated despite correction of the apparent type A causes.<br /><br />Because persistent hypoperfusion was no longer present, the team investigated type B lactic acidosis. Workup for malignancy, liver failure, diabetes, and medication causes was unrevealing. The patient’s thiamine level was low. He was treated with IV thiamine 200 mg every 8 hours for 3 days, followed by oral thiamine 100 mg daily. After treatment, his lactate improved from 2.4 to 1.6 mmol/L.<br /><br />The case emphasizes that thiamine deficiency should be considered in patients with persistent lactic acidosis, especially those with poor nutrition or alcohol use disorder. Thiamine is an essential cofactor in carbohydrate metabolism; when deficient, pyruvate cannot enter the Krebs cycle and is instead converted to lactate. In patients with limited intake, body stores may be depleted within weeks, and alcohol use can worsen both intake and absorption.<br /><br />Overall, the poster highlights the importance of evaluating uncommon causes of ongoing lactic acidosis after common type A causes have resolved, since untreated thiamine deficiency can lead to serious complications.

Asset Subtitle

Taylor Purzycki

Meta Tag

Author List Anjana Pillai, Taylor Purzycki

Category Clinical Vignettes

Concept Thiamine Deficiency

Concept Type B Lactic Acidosis

Concept Pyruvate Metabolism

Concept Type A Lactic Acidosis

Concept Persistent Lactate Elevation

Distinguished Non-Finalist

Presenter Organization Morristown Medical Center

Presenting Author Taylor Purzycki

Track Adult

Keywords

thiamine deficiency

lactic acidosis

alcohol use disorder

vitamin C deficiency

scurvy

Dieulafoy lesion

melena

type B lactic acidosis

poor nutrition

hypotension

Thiamine Deficiency

Type B Lactic Acidosis

Pyruvate Metabolism

Type A Lactic Acidosis

Persistent Lactate Elevation