
    no participant enrolled
  
['septic shock', 'shock, septic', 'lactic acidosis', 'thiamine deficiency']
['thiamine', 'placebos']

        Inclusion Criteria:

          -  Age>18

          -  Sepsis (defined as presence of two or more SIRS criteria with documented or suspected
             infection)

          -  SIRS: Systemic Inflammatory Response Syndrome (SIRS) is the occurrence of at least two
             of the following criteria: temperature >38.0ºC or <36.0ºC, heart rate >90
             beats/minute, respiratory rate >20 breaths/minute, white blood cell count >12,000 or
             <4000.

          -  Lactate >3mmol/L at the time of consent and randomization

          -  Hypotension (systolic blood pressure <90mmHg) after a >2L fluid bolus

          -  Vasopressor dependence (defined as the continuous infusion of norepinephrine,
             dopamine, phenylephrine, vasopressin or epinephrine.)

        Exclusion Criteria:

          -  Known cirrhosis or chronic liver disease

          -  Current thiamine supplementation

          -  Clinical indication for thiamine (e.g. Alcohol abuse)

          -  Comfort measures only designation

          -  Inability to provide consent

          -  Other causes for lactate elevation (seizure, use of medications that can cause lactic
             acidosis such as metformin, linezolid and anti-retrovirals, carbon monoxide, known or
             suspected bowel or limb ischemia, cardiac arrest prior to enrollment)
      