THE USE OF THIAMINE IN INTENSIVE THERAPY OF PATIENTS IN CRITICAL CONDITION

The clinical cases of treatment of two patients in critical conditions by intravenous thiamine are described.

In the first clinical case, in addition to intensive therapy, the patient was administered 300 mg of thiamine by intravenous titration for 10 hours, followed by a daily titration of 100 mg of thiamine and the administration of a complex of fat-soluble vitamin “Vitalipid N.” The basis for the appointment of thiamine was an increase in the level of lactate (19.0 mmol/l), with clear consciousness, effective breathing, adequate oxygenation, stable hemodynamics. Intravenous use of thiamine led to the stabilization of the patient’s homeostasis, normalization of clinical and some laboratory indicators (2.0 mmol/l), reflecting the presence of thiamine deficiency.

In the second clinical case, there was a lack of evacuation of gastric contents into the intestine, an increase in the level of lactate (3.3 mmol/l) in the patient in the critical condition, in the postoperative period with clear consciousness, effective independent breathing, adequate oxygenation, stable hemodynamics, good peristalsis. After excluding the main possible causes of increased lactate levels (hypoxia, liver failure), the patient was prescribed 100 mg of thiamine intravenously by titration within an hour. The introduction of thiamine, the subsequent recovery of enteral nutrition led to the cessation of parenteral nutrition, rapid positive dynamics of the general condition, the normalization of the lactate level (0.9 mmol/l). 

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