Low Thiamine Levels in Children With Type 1 Diabetes and Diabetic Ketoacidosis: A Pilot Study

Objective: Thiamine deficiency has been documented in adults with diabetes and in a single report of reversible encephalopathy in a child with diabetic ketoacidosis. In children who present with severe diabetic ketoacidosis, one of the most serious complications is cerebral edema of which the primary symptom may be encephalopathy. Thiamine deficiency in other disease states has been clearly linked with acute encephalopathy, but there are no data on thiamine status in children with diabetic ketoacidosis. This study describes the prevalence of thiamine deficiency in children with type 1 diabetes mellitus who present with diabetic ketoacidosis and are admitted to the ICU. Design: A prospective observational pilot study. Setting: PICU in a tertiary care children's hospital. Patients: Children 2-18 years admitted to the ICU for treatment of diabetic ketoacidosis. Interventions: Treatment of diabetic ketoacidosis. Measurements and Main Results: Twenty-two patients were enrolled. The mean age was 13.7 +/- 3.6 years. Five of 21 patients (23.8%) had thiamine deficiency prior to insulin administration. After 8 hours of insulin therapy, seven of 20 patients (35%) had thiamine deficiency, and four of these seven patients also had thiamine deficiency at presentation. Sixty-eight percent of patients had a decrease in thiamine levels after 8 hours of insulin therapy, with a mean fall of 20 +/- 31.4 nmol/L. Conclusions: Thiamine deficiency is common in children with diabetic ketoacidosis, and this deficiency may be worsened by treatment. When metabolic acidosis persists despite appropriate treatment of diabetic ketoacidosis, other factors such as thiamine deficiency should be considered.