Thiamine as a Metabolic Resuscitator in Septic Shock

Thiamine as a Metabolic Resuscitator in Septic Shock

The major goal of this project is to determine whether the use of thiamine in patients with septic shock will result in attenuation of lactic acidosis and a more rapid reversal of shock.

Inclusion Criteria:

• Greater than 18 years old
• Suspected or confirmed source of infection
• Hypotension (systolic pressure <90 mmHg) after a minimum 2 liter fluid bolus followed by vasopressor-dependence.
• Lactic Acidosis > 3 mmol/dl

Exclusion Criteria:

• Competing cause of lactic acidosis including: seizures within 3 hours of enrollment, use of linazolid metformin or anti-retrovirals at the time of enrollment, carbon monoxide or cyanide poisoning, highly suspected or known ischemic bowel, and known mitochondrial disorders
• Liver dysfunction specifically defined as AST or ALT elevation greater than 240
• Current Thiamine supplements or usage
• Competing indication for thiamine administration
• Cardiac Arrest
• DNR/DNI or comfort care status (DNR status in an intubated patient receiving full care is eligible)