Thiamine as a Metabolic Resuscitator in Septic Shock

Inclusion Criteria: * Greater than 18 years old * Suspected or confirmed source of infection * Hypotension (systolic pressure \<90 mmHg) after a minimum 2 liter fluid bolus followed by vasopressor-dependence. * Lactic Acidosis \> 3 mmol/dl Exclusion Criteria: * Competing cause of lactic acidosis including: seizures within 3 hours of enrollment, use of linazolid metformin or anti-retrovirals at the time of enrollment, carbon monoxide or cyanide poisoning, highly suspected or known ischemic bowel, and known mitochondrial disorders * Liver dysfunction specifically defined as AST or ALT elevation greater than 240 * Current Thiamine supplements or usage * Competing indication for thiamine administration * Cardiac Arrest * DNR/DNI or comfort care status (DNR status in an intubated patient receiving full care is eligible)