The only valid measure of thiamine status is measurement of red cell
transketolase before and after thiamine treatment.
Having supervised a project for development of a RCT assay, I calculated
that the cost of the assessment of thiamine status would buy thiamine
tablets for 60 yrs.
The same argument applies to Vitamin C assessment
with best wishes
Richard
Richard Mainwaring-Burton
Consultant Biochemist
Queen Mary's Hospital
Sidcup, Kent
DA14 6LT
020-8308-3084
-----Original Message-----
From: Williams David G (RLN) City Hospitals Sunderland - Clinical
Scientist [mailto:[log in to unmask]]
Sent: 16 June 2004 10:13
To: [log in to unmask]
Subject: Re: A metabolic pickle
Or you can measure thiamine status
David G Williams
-----Original Message-----
From: Paul Holloway
[mailto:[log in to unmask]]
Sent: 16 June 2004 10:09
To: [log in to unmask]
Subject: Re: A metabolic pickle
A glucose challenge was an original diagnostic test for thiamine
deficiency - deficient patients producing significantly elevated
lactate/pyruvate ratios - for obvious reasons.
regards
Paul Holloway
>>> Mohammad Al-Jubouri <[log in to unmask]> 06/16/04 9:52 AM >>>
Elizabeth
I think your money is safe. As I said the patient did receive pabrinex
(a multivitamin cocktail containing adequate dose of thiamine). A source
of carbohydrate (like 10% dextrose) was also given to prevent
aggravation of thiamine deficiency state.
regards
Mohammad
Elizabeth Mac Namara <[log in to unmask]> wrote:
I would still put my money on thiamine deficiency unless you can be sure
that no multivitamin cocktail was given and he recovered without
thiamine. There is a lovely case in the literature, from many years ago,
of a patient not been able to keep their pH normal, even with huge
amounts of bicarb, until he received thiamine. Unfortunately I do not
have the reference for you but I am also sure he was an alcoholic
Liz Mac Namara
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]]On Behalf Of Mohammad
Al-Jubouri
Sent: June 15, 2004 10:47 AM
To: [log in to unmask]
Subject: Re: A metabolic pickle
Thanks to all replies
Most of you agree that this represents a case of alcoholic ketoacidosis
but find the accompanying lactic acidosis atypical. There are at least 3
further samples showing less severe metabolic derangement during her
therapy with saline infusion, 10% dextrose/insulin infusion and
pabrinex. This is therefore a genuine metabolic derangement and citrate
contamination is not to blame. She needed potassium, magnesium and
phosphate supplements as you might expect with treated metabolic
acidosis. Her biochemical parameters quickly recovered back to normal
within 24 hours. The hypochloraemia due to vomiting has exaggerated the
calculated anion gap. The osmolal gap can probably be expalined by
ethanol (30 mmol) + lactate (15 mmol) and B-OH-Butyrate (15 mmol), but I
am still waiting for toxic alcohols screen.
Learning point: Profound hyperlactataemia can accompany alcoholic
ketoacidosis.
Regards
Mohammad
Mohammad Al-Jubouri <[log in to unmask]> wrote:
Dear All
A 62-year-old lady presented with short history of vomiting and
breathlessness. Physical examination was unremarkable!!, CXR normal. A
biochemical profile showed:
U/E: Na 143 mmol/L, K 4.6 mmol/L, urea 8.3 mmol/L, creatinine 150
umol/L, chloride 87 mmol/L, bicarbonate 8.0 mmol/L.
LFTs: Bilirubin 12 umol/L, ALP 102 IU/L, ALT 39 IU/L, AST 67 IU/L, GGT
42 IU/L, albumin 46 g/L.
Others: glucose 11.2 mmol/L, CK 67 IU/L, adjusted calcium 2.24 mmol/L,
phosphate 3.44 mmol/L, osmolality 361 mOsm/kg, CRP < 5 mg/L, INR 1.0
Acid base status: pH 7.13 kPa, PCO2 2.7 kPa, PO2 11.2 kPa
Anion gap 54 mmol/L
Osmolal gap > 50 mmol/L
Lactate 15 mmol/L
Beta-hydroxybutyrate 15 mmol/L
Serum alcohol 136 mg/dL
Toxic alcohols screen: to follow.
Drug history: None.
Alcohol drinking: ++++
Impression: Profound combined lactic/ ketoacdosis.
Question: can all this be due to alcohol only? have you had any
experience with a similar case, would be grateful for your comments.
regards
Mohammad
Dr. M A Al-Jubouri
Consultant Chemical Pathologist
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