Duell T, Mittermüller J, Hiddemann W
Medizinische Klinik III, Klinikum Grosshadern, Ludwig-Maximilians-Universität München.
Dtsch Med Wochenschr. 2000 Oct 13;125(41):1232-4. doi: 10.1055/s-2000-7725.
A severely ill 84-year old patient, known to suffer from a chronic congestive heart failure, was admitted to the emergency room because of increasing dyspnea. His blood pressure was stable (125/80), his heart rate normal (66/min), the respiratory rate, however, was elevated at 35/min and he exhibited substantial peripheral edema. There were no signs indicating an infectious process.
Blood gas analysis yielded a marked, respiratorically compensated metabolic acidosis with a base excess of -8.6. The chest roentgenography showed a markedly dilated heart without pulmonary-vascular congestion or infiltrates. The serum lactate was substantially increased at 11.4 mmol/l (0.6-2.44).
A cardiovascular beriberi syndrome was suspected and 100 mg of thiamine administered i.v. Within hours the clinical picture improved significantly. Two hours after administration of thiamine serum lactate concentration was 5.7 mmol/l, about 12 hours later the patient suffered no longer from dyspnea and the lactate was at a normal level.
Thiamine deficiency as a cause for an elevated serum lactate or lactate acidosis with or without cardiovascular failure may not be overlooked. Without adequate treatment it may end lethally, although it can be treated easily, effectively and without side effects. The potential frequency of thiamine deficiency among the normal population even in our society may be under-estimated due to the particular properties of this vitamin.
一名84岁的重症患者，已知患有慢性充血性心力衰竭，因呼吸困难加重被送入急诊室。他的血压稳定（125/80），心率正常（66次/分钟），然而呼吸频率升高至35次/分钟，且有明显的外周水肿。没有迹象表明存在感染过程。
血气分析显示为明显的、呼吸代偿性代谢性酸中毒，碱剩余为-8.6。胸部X线检查显示心脏明显扩大，无肺血管充血或浸润。血清乳酸显著升高至11.4 mmol/l（0.6 - 2.44）。
怀疑为心血管型脚气病综合征，静脉注射100毫克硫胺素。数小时内临床症状明显改善。注射硫胺素两小时后血清乳酸浓度为5.7 mmol/l，约12小时后患者不再呼吸困难，乳酸水平恢复正常。
硫胺素缺乏作为血清乳酸升高或乳酸酸中毒的原因，无论有无心力衰竭都不应被忽视。尽管它可以轻松、有效且无副作用地进行治疗，但如果没有适当治疗可能会致命。由于这种维生素的特殊性质，即使在我们的社会中，普通人群中硫胺素缺乏的潜在发生率可能也被低估了。
