Duca James, Lum Corey J, Lo Angela M
John A. Burns School of Medicine, 651 Ilalo St., Honolulu, 96813, HI, USA.
University of Hawaii Internal Medicine Program, 1356 Lusitana St. # 510, Honolulu, 96813, HI, USA.
J Gen Intern Med. 2016 Jan;31(1):133-6. doi: 10.1007/s11606-015-3326-2. Epub 2015 Apr 16.
Thiamine deficiency usually occurs with prolonged nutritional deficiency and is almost universally identified with Wernicke's encephalopathy or beriberi. It is also, however, a rare cause of elevated lactate and gastroenterological symptoms. This case report describes a 30-year-old man with 2 weeks of gastroenterological symptoms and intermittent oral intake, who was found to have an elevated lactate level. Neurological exam was normal and an extensive workup was negative, but after being treated with thiamine, his lactate level improved overnight and all of his symptoms resolved. Thiamine levels returned low at 44 nmol/L (normal 78-185 nmol/L). Lack of recognition of this phenomenon, while rare, can lead to unnecessary tests and procedures and increased morbidity and mortality.
硫胺素缺乏通常发生于长期营养缺乏的情况下，几乎普遍与韦尼克脑病或脚气病相关。然而，它也是导致乳酸水平升高和出现胃肠症状的罕见原因。本病例报告描述了一名30岁男性，有两周的胃肠症状且经口摄入断断续续，发现其乳酸水平升高。神经系统检查正常，全面检查结果均为阴性，但在接受硫胺素治疗后，其乳酸水平一夜之间有所改善，所有症状均消失。硫胺素水平恢复至较低水平，为44纳摩尔/升（正常范围为78 - 185纳摩尔/升）。虽然这种现象罕见，但未认识到这一点可能会导致不必要的检查和程序，并增加发病率和死亡率。
