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- Rachel Jaber Chehayeb, Ysabel C Ilagan-Ying, and Christopher Sankey.
- General Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
- J Gen Intern Med. 2023 May 1; 38 (6): 154715511547-1551.
AbstractWe present the case of a young woman admitted for diabetic ketoacidosis with persistent, asymptomatic lactic acid (LA) elevation during the evolving COVID-19 pandemic. Cognitive biases in interpreting an elevated LA in this patient's care resulted in an extensive infectious workup instead of the low-cost and potentially diagnostic provision of empiric thiamine. We discuss clinical patterns and etiologies of LA elevation and the role of thiamine deficiency. We also address cognitive biases potentially affecting the interpretation of elevated lactate levels and provide guidance for clinicians to determine appropriate patients for empiric thiamine administration.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.
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