Addressing Cognitive Biases in Interpreting an Elevated Lactate in a Patient with Type 1 Diabetes and Thiamine Deficiency
Open accessAbstract
We 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.
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In case 13, a young patient presenting with lactic acidosis was initially diagnosed with diabetic ketoacidosis, and further discussions within the multi-agent environment led to the identification of thiamine deficiency.
“For instance, in case 13 [44], a young patient presenting with lactic acidosis was initially diagnosed with diabetic ketoacidosis, and further discussions within the multi-agent environment led to the identification of thiamine deficiency.”
From Mitigating cognitive biases in clinical decision-making through multi-agent conversations using large language models: simulation study (2024) · cites this paper as [44]
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“…Anaphylaxis secondary to henna 2022 [43] Pneumothorax Pulmonary embolism 2023 [33] Thiamine deficiency Diabetic ketoacidosis with infections 2023 [44] Ischemic bowel Endometritis 2023 [45] Acute myocarditis caused by invasive bacterial infection Acute myocarditis likely due to MIS-C a 2023 [46]…”
- Authors
- Chehayeb, R. J., Ilagan-Ying, Y. C., & Sankey, C.
- Affiliations
- Yale University (US)
- Yale New Haven Hospital (US)
- Corresponding author
- Sankey, Christopher
- Venue
- Journal of General Internal Medicine
- Published
- 2023-02-22
- Volume
- 38
- Issue
- 6
- Pages
- 1547-1551
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC9946700
- OpenAlex
- W4321482869
- Cited by
- 4
- References
- 30
- Citations by year
- 2026: 3 · 2024: 1
- FWCI
- 1.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Yale University
- National Institutes of Health (UL1TR001863)
- Raymond and Beverly Sackler Institute for Biological, Physical and Engineering Sciences, Yale University
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- hyperlactatemia, thiamine deficiency, type 1 diabetes, diabetic ketoacidosis, cognitive biases, diagnostic decision-making, COVID-19 pandemic, diagnostic workup
- MeSH terms
- COVID-19, Beriberi, Cognition, Diabetes Mellitus, Type 1, Female, Humans, Thiamine, Thiamine Deficiency, Bias, Lactic Acid, Pandemics
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