[Unclear lactate acidosis in a patient with heart failure under long-term diuretic therapy].

Abstract

HISTORY AND CLINICAL PRESENTATION:

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.

EXAMINATIONS:

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).

TREATMENT AND COURSE:

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.

CONCLUSION:

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.

• Authors: T Duell, J Mittermüller, W Hiddemann
• Journal: Deutsche medizinische Wochenschrift (1946) (Dtsch Med Wochenschr) Vol. 125 Issue 41 Pg. 1232-4 (Oct 13 2000) ISSN: 0012-0472 [Print] Germany
• Vernacular Title: Unklare Laktatazidose bei einem Patienten mit Herzinsuffizienz unter diuretischer Langzeit-Therapie.
• PMID: 11076262 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Diuretics
• Lactates
• Furosemide
• Thiamine

Topics

• Acidosis, Lactic (diagnosis, etiology)
• Aged
• Aged, 80 and over
• Diuretics (administration & dosage)
• Dyspnea (etiology)
• Furosemide (administration & dosage)
• Heart Failure (complications, diagnosis, drug therapy)
• Humans
• Lactates (blood)
• Male
• Thiamine (administration & dosage, therapeutic use)
• Thiamine Deficiency (complications, drug therapy, etiology)