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Background <p>Diabetic ketoacidosis (DKA) is a critical complication of type 1 diabetes in children, often accompanied by lactic acidosis. Thiamine (vitamin B1) is essential for carbohydrate metabolism, and its deficiency may exacerbate metabolic disturbances in DKA. However, the prevalence and clinical impact of thiamine deficiency in pediatric DKA remain underexplored.</p> Objective <p>To assess the prevalence and clinical significance of thiamine deficiency among pediatric patients presenting with diabetic ketoacidosis (DKA).</p> Methods <p>This prospective, multicenter observational study included 204 children aged 1&#xa0;month to 12&#xa0;years admitted with DKA to three tertiary care centers from October 2022 to August 2024. Thiamine and its phosphate esters were measured at admission. Their associations with biochemical parameters, DKA severity, time to resolution, PICU stay, morbidity, and mortality were analyzed.</p> Results <p>Of 204 children (mean age 7.3 ± 3.3&#xa0;years), 78% were thiamine deficient. Thiamine levels were significantly lower in underweight children and those with severe DKA. Thiamine deficiency showed an inverse correlation with lactate (<i>r</i> = -0.306, <i>p</i> = 0.022) and a positive correlation with bicarbonate (<i>r</i> = 0.264, <i>p</i> = 0.050). Lower thiamine levels were associated with prolonged DKA resolution (<i>r</i> = -0.263, <i>p</i> = 0.04) and higher mortality (<i>p</i> = 0.001). Baseline lactate correlated positively with resolution time and mortality.</p> Conclusions <p>Thiamine deficiency is highly prevalent in pediatric DKA and is associated with greater acidosis, delayed recovery, and increased mortality. These findings highlight the importance of assessing thiamine status in children with DKA and suggest a potential role for thiamine supplementation in improving outcomes. Further randomized trials are warranted.</p>

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Assessment of thiamine levels in paediatric diabetic ketoacidosis and their influence on recovery and length of hospital stay

  • 期刊论文

  • 发表日期：

    2026年1月23日

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  • Rajesh Sharma,
  • Gaurav Sharma,
  • Prachi Kumar,
  • Aditya Dixit,
  • Rahul Bhargava,
  • Sulakshana S. Baliga

摘要

Background

Diabetic ketoacidosis (DKA) is a critical complication of type 1 diabetes in children, often accompanied by lactic acidosis. Thiamine (vitamin B1) is essential for carbohydrate metabolism, and its deficiency may exacerbate metabolic disturbances in DKA. However, the prevalence and clinical impact of thiamine deficiency in pediatric DKA remain underexplored.

Objective

To assess the prevalence and clinical significance of thiamine deficiency among pediatric patients presenting with diabetic ketoacidosis (DKA).

Methods

This prospective, multicenter observational study included 204 children aged 1 month to 12 years admitted with DKA to three tertiary care centers from October 2022 to August 2024. Thiamine and its phosphate esters were measured at admission. Their associations with biochemical parameters, DKA severity, time to resolution, PICU stay, morbidity, and mortality were analyzed.

Results

Of 204 children (mean age 7.3 ± 3.3 years), 78% were thiamine deficient. Thiamine levels were significantly lower in underweight children and those with severe DKA. Thiamine deficiency showed an inverse correlation with lactate (r = -0.306, p = 0.022) and a positive correlation with bicarbonate (r = 0.264, p = 0.050). Lower thiamine levels were associated with prolonged DKA resolution (r = -0.263, p = 0.04) and higher mortality (p = 0.001). Baseline lactate correlated positively with resolution time and mortality.

Conclusions

Thiamine deficiency is highly prevalent in pediatric DKA and is associated with greater acidosis, delayed recovery, and increased mortality. These findings highlight the importance of assessing thiamine status in children with DKA and suggest a potential role for thiamine supplementation in improving outcomes. Further randomized trials are warranted.