Conference abstract

Acute respiratory failure and thiamine deficiency in Africa, Guinea Bissau

Pan African Medical Journal - Conference Proceedings. 2018:9(23).14 Dec 2018.
doi: 10.11604/pamj-cp.2018.9.23.750

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Keywords: Thiamine deficiency, acute respiratory failure, Africa
Poster

Acute respiratory failure and thiamine deficiency in Africa, Guinea Bissau

Kelly Escajadillo1,&, Merce Roscapan2, Laurent Hiffler3

1Médecins Sans Frontières, OCBA, Bafata, Guinea Bissau, 2Médecins Sans Frontières, OCBA, Barcelona, Spain, 3Médecins Sans Frontières, OCBA, Paediatric Service, Dakar Unit, Dakar, Senegal

&Corresponding author
Kelly Escajadillo, Médecins Sans Frontières, OCBA, Bafata, Guinea Bissau

Abstract

Introduction: acute thiamine deficiency (TD) in infancy is well described in Asia but poorly documented in Africa. Critically ill patients have increased thiamine body consumption (associated with hyper metabolism) and dextrose-based IV fluid increase thiamine cellular demand even further. Parenteral nutrition with vitamins is not a current practice in many resources limited settings. Consequently, severe acute conditions might result in TD or trigger TD signs in patients with borderline thiamine status, with life threatening consequences.

Methods: a critically ill 3-months old infant was admitted for acute respiratory distress with a working diagnosis of complicated pneumonia, fever, tachypnea with bilateral crackles, tachycardia, no edemas, poor feeding and hypotonia. Malaria rapid test was negative. He received IV ceftriaxone, IV fluids maintenance (RL/D5%) and O2 to maintain SpO2 > 92%. 8 hours later (H8), his condition worsened with hypoxia, lethargy and toxic appearance. Anti-Staphylococcal antibiotic was added (cloxacillin). At H48 in the absence of improvement, azithromycin, trial of steroids and bronchodilators and feeding via gastric tube were commenced. At H52 he was exhausted with intense respiratory distress, increased O2 needs and was also unconscious.

Results: in front of this worsening life threatening condition a trial of IV Thiamine 100mg (slow infusion) was decided and followed by a rapid clinical improvement. In 12 hours, respiratory distress and O2 needs reduced significantly. 24 hours after the first thiamine dose, he was alert, holding his head, breastfeeding and off O2 at 48h.

Conclusion: the rapid and unequivocal reversal of severe respiratory symptoms in this critical patient with a worsening condition is in favor of acute TD. The administration of slow intravenous thiamine should be based on clinical grounds. Clear rapid response to thiamine is considered diagnostic. This is a cheap and life-saving drug but often not available in many African settings. There is a need to increase medical awareness and implement studies on TD prevalence in Sub-Saharan African.