SHM Converge Scientific Abstract ePoster Gallery-Type B Lactic Acidosis - A Case of Prolonged Starvation in a Diabetic Patient.

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This case report describes a 46-year-old man with severe chronic disability, diabetes, and long-term feeding tube dependence who developed marked anion-gap metabolic derangement while hospitalized after a G-J tube dislodgement. Because the tube could not be reliably replaced and surgery was not an option, he remained NPO for several days on IV fluids. On hospital day four, he became hypoglycemic and developed elevated anion gap, low bicarbonate, ketonemia, and very high lactate (9.0 mmol/L), despite being well perfused and not showing evidence of ischemia or shock.<br /><br />The team treated him with dextrose-containing fluids, insulin sliding scale, and IV thiamine. Within six hours, his anion gap closed, bicarbonate improved, and lactate rapidly normalized, supporting thiamine deficiency as the cause of type B lactic acidosis rather than diabetic ketoacidosis alone. Palliative care was consulted, and the guardian chose hospice.<br /><br />The report emphasizes that starvation ketosis in diabetic patients may coexist with severe lactic acidosis, and that ketones alone cannot explain such profound lactate elevation. Thiamine deficiency can develop quickly in malnourished, critically ill, or tube-feed-dependent patients, especially during prolonged inadequate intake or physiologic stress. Because thiamine is required for aerobic metabolism and the Krebs cycle, deficiency shifts pyruvate toward lactate production, causing type B lactic acidosis.<br /><br />The key message is that thiamine deficiency is common, underrecognized, inexpensive to treat, and should be considered early in malnourished or enteral-feeding-dependent patients with unexplained lactic acidosis.

Asset Subtitle

Sumera Andleeb

Meta Tag

Author List Amrit Pannu, Parag Chevli, Sumera Andleeb

Category Clinical Vignettes

Concept Thiamine Deficiency

Concept Type B Lactic Acidosis

Concept Lactic Acidosis

Concept Thiamine Therapy

Concept Malnutrition

Distinguished Non-Finalist

Presenter Organization Wake Forest

Presenting Author Sumera Andleeb

Track Adult

Keywords

thiamine deficiency

type B lactic acidosis

anion gap metabolic acidosis

starvation ketosis

diabetes mellitus

enteral feeding dependence

hypoglycemia

ketonemia

lactate elevation

malnutrition

Thiamine Deficiency

Type B Lactic Acidosis

Lactic Acidosis

Thiamine Therapy

Malnutrition