Thiamine supplementation increases serum thiamine and reduces pyruvate and lactate levels in burn patients

Falder, Sian; Silla, Robyn; Phillips, Michael; Rea, Suzanne; Gurfinkel, Reuven; Baur, Esther; Bartley, Anthony; Wood, Fiona M.; Fear, Mark W.

doi:10.1016/j.burns.2009.04.012

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Volume 36, Issue 2 , Pages 261-269, March 2010

Thiamine supplementation increases serum thiamine and reduces pyruvate and lactate levels in burn patients

Sian Falder
- The McComb Research Foundation, Perth, WA, Australia
- Royal Perth Hospital, Perth, WA, Australia
Robyn Silla
- The McComb Research Foundation, Perth, WA, Australia
- Royal Perth Hospital, Perth, WA, Australia
Michael Phillips
- Western Australian Institute for Medical Research, University of Western Australia, Perth, WA, Australia
- Royal Perth Hospital, Perth, WA, Australia
Suzanne Rea
- The McComb Research Foundation, Perth, WA, Australia
- Royal Perth Hospital, Perth, WA, Australia
- Princess Margaret Hospital for Children, Perth, WA, Australia
Reuven Gurfinkel
- Royal Perth Hospital, Perth, WA, Australia
- Princess Margaret Hospital for Children, Perth, WA, Australia
Esther Baur
- The McComb Research Foundation, Perth, WA, Australia
Anthony Bartley
- The McComb Research Foundation, Perth, WA, Australia
- Royal Perth Hospital, Perth, WA, Australia
Fiona M. Wood
- The McComb Research Foundation, Perth, WA, Australia
- Royal Perth Hospital, Perth, WA, Australia
- Princess Margaret Hospital for Children, Perth, WA, Australia
- School of Pediatrics, University of Western Australia, Perth, WA, Australia
Mark W. Fear
- The McComb Research Foundation, Perth, WA, Australia
- Corresponding author at: The McComb Foundation, Telstra Burn Outcome Centre, 11th floor, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia. Tel.: +61 8 9224 3567; fax: +61 8 9202 1145.

Accepted 11 April 2009.

Abstract

The importance of vitamins for optimal metabolism is well established. However, currently little is known about the optimal vitamin levels required for burn patients. As a consequence, current practice both for macronutrient supplementation and vitamin supplementation varies widely between burn units. A better understanding of the effects of vitamins on metabolism may lead to better nutrition and subsequently improved outcomes for burn patients.

Thiamine is an important co-factor required for multiple enzymes involved in carbohydrate metabolism. We have examined the levels of thiamine (B1) in burn patients as well as the effects of thiamine supplementation on the levels of serum thiamine, pyruvate and lactate.

Twenty patients had blood samples taken on the day of admission, then on days 1, 3, and 7 post-admission and weekly thereafter until discharge. Of these, nine received enteral feeding. Six patients received thiamine supplementation. Serum thiamine, pyruvate and lactate levels were measured at each time point.

Serum thiamine levels increased significantly with thiamine supplementation (p<0.001). Serum thiamine levels also increased with time of supplementation (p<0.001). Serum thiamine level was closely associated with pyruvate and lactate levels, with a decrease in both pyruvate and lactate associated with increased serum thiamine. Lastly, pyruvate and lactate levels appear closely associated in a linear relationship.

This study suggests thiamine supplementation increases serum thiamine and that this increase is associated with a decrease in pyruvate and lactate levels. Further study of changes in metabolic flux associated with thiamine supplementation and a randomised control trial of thiamine supplementation are required to establish whether thiamine supplementation is beneficial to burn patients’ metabolism and recovery.

Keywords: Burn injury, Metabolism, Pyruvate, Thiamine supplementation