Cardiac Dysfunction Due to Thiamine Deficiency after Hemodialysis for Biguanide-related Lactic Acidosis

Abstract

Biguanide is an ideal drug for the treatment of type 2 diabetes mellitus. When used appropriately, the incidence of lactic acidosis is reported to be very low. Risk factors associated with biguanide-related lactic acidosis include chronic kidney disease, congestive heart failure, alcohol use, severe dehydration, shock, hypoxic states, sepsis, and advanced age. We herein report a case of cardiac dysfunction due to thiamine deficiency after hemodialysis in a patient with suspected biguanide-related lactic acidosis. Patients who develop severe lactic acidosis while taking biguanides should be given a large dose of thiamine without delay, given the possibility of thiamine deficiency as a complication.

Keywords: cardiac dysfunction; lactic acidosis; metformin; thiamin deficiency.

Figure 1.

Clinical course of the patient’s lactic acidosis. With the start of CHDF, the lactate levels decreased rapidly, and the metabolic acidosis improved. HD on day 6 was the final dialysis procedure, as the amount of urine increased. HD: hemodialysis, CHDF: continuous hemodiafiltration

Figure 2.

Clinical course of the patient’s cardiac function and serum BNP level. The patient’s marked reduction in the left ventricular systolic function was reversed by the administration of high-dose thiamine. The serum BNP level decreased significantly. Each arrow indicates the intravenous administration of thiamine chloride hydrochloride. LVEF: left ventricular ejection fraction, BNP: brain natriuretic peptide