Semaglutide use and restrictive diet linked to severe perioperative lactic acidosis, reversed by thiamine
Background
Thiamine deficiency is a rare but potentially fatal cause of type B lactic acidosis, typically associated with conditions like alcoholism or severe malnutrition. In the perioperative setting, surgical stress can exacerbate underlying nutritional vulnerabilities. While glucagon-like peptide-1 (GLP-1) receptor agonists like semaglutide are effective for weight loss, their marked appetite suppression and potential for gastrointestinal side effects can increase the risk of nutritional deficiencies, including thiamine deficiency, which may remain unmasked until a significant physiological stressor occurs.
Study Design
This case report details a young, non-diabetic woman with a history of prior semaglutide use and a restrictive diet who underwent a total abdominal hysterectomy. Postoperatively, she developed severe lactic acidosis and hyperglycemia. Despite maintaining hemodynamic stability and receiving adequate hydration, her lactate levels continued to worsen. Given the clinical picture, empiric administration of intravenous thiamine was initiated as a therapeutic intervention to address potential underlying deficiency.
Results
Following the administration of empiric intravenous thiamine, the patient exhibited a rapid and significant clinical improvement. Both her severe lactic acidosis and hyperglycemia normalized quickly. The abstract highlights that her lactate levels had been worsening despite standard supportive measures, including hemodynamic stability and adequate hydration, underscoring the specific role of thiamine in resolving the metabolic derangement. This response strongly implicated thiamine deficiency as the root cause, likely unmasked by the perioperative stress in the context of her restrictive diet and prior semaglutide use. No specific numerical values for lactate or glucose levels were provided in the abstract, but the qualitative description emphasizes the dramatic and rapid reversal. The case suggests that:
Empiric intravenous thiamine produced rapid normalization of both lactate and glucose.
Key Findings
- A young, non-diabetic woman with prior semaglutide use and restrictive dieting developed severe perioperative lactic acidosis and hyperglycemia.
- Lactate levels worsened despite hemodynamic stability and adequate hydration post-surgery.
- Empiric intravenous thiamine administration led to rapid normalization of both lactate and glucose.
- Prior semaglutide use and restrictive dieting may unmask thiamine deficiency under perioperative stress.
Why It Matters
This case highlights a critical, often overlooked, risk for individuals on GLP-1 receptor agonists and restrictive diets, particularly in the perioperative period. The finding underscores the importance of a comprehensive preoperative nutritional risk assessment for patients undergoing surgery who have a history of significant weight loss, restrictive eating patterns, or GLP-1 agonist use. Clinicians should consider early empiric thiamine administration in cases of unexplained perioperative lactic acidosis, even in non-alcoholic patients, as delaying treatment can have severe consequences. This suggests a potential modification to standard perioperative protocols, advocating for a lower threshold for thiamine supplementation in at-risk populations to prevent or rapidly reverse life-threatening metabolic complications.
semaglutide
lactic-acidosis
thiamine-deficiency
restrictive-diet
perioperative
case-report