P037: TREATMENT OF SEVERE LACTIC ACIDOSIS WITH THIAMINE IN A CADAVERIC KIDNEY TRANSPLANT RECIPIENT.
Kianfa Martinez-Lu, Sina Ghaffaripour; Jackson Memorial Hospital
A 62-year-old male patient with end-stage renal failure, who recently underwent a cadaveric liver transplant developed unexplained severe lactic acidosis (LA) during allograft renal transplantation. All the causes of lactic acidosis were investigated without having a clue. Empiric treatment with sodium bicarbonate was ineffective in treating acidemia. Postoperatively, intravenous administration of thiamine resulted in rapid improvement of LA. Low perfusion pressure, liver dysfunction and thrombotic arterial occlusion are the common causes of the lactic acidosis. Though a rare entity, acute thiamine deficiency should be considered in the differential diagnosis of unexplained severe LA in patients with chronic kidney disease and hemodialysis who undergo major surgery or admitted to critical care units. Uremia and chronic hemodialysis might be responsible for the quantitative/qualitative deficiency of thiamine unmasked during the surgical stress.
LA treated successfully with thiamine in different scenarios. Though chronic renal failure (CRF) and hemodialysis are proven risk factors for occult thiamine deficiency, this is only the second case report describing the reversal of acute refractory LA with intravenous (IV) thiamine in the setting of kidney transplantation.