Severe lactic acidosis and thiamine deficiency during total parenteral nutrition--case report.
We encountered a case of total parenteral nutrition-associated lactic acidosis that did not respond to sodium bicarbonate or other conventional emergency treatments. He was characterized by minimal food intake before surgery, delayed gastric emptying after pylorus-preserving pancreatoduodenectomy due to pancreas head cancer and long-term total parenteral nutrition without food intake and vitamin supplements after surgery. After thiamine administration, the patient very quickly recovered with dramatic reestablishment of the acid-base balance. We emphasize the need to supplement total parenteral nutrition with thiamine-containing vitamins for the patients whose food intake does not meet nutritional requirements and to intravenously replenish using high-dose thiamine simultaneously with the manifestation of signs and symptoms of severe lactic acidosis with unknown cause. In conclusion, thiamine deficiency should be included in the differential diagnosis of lactic acidosis for the patients who received total parenteral nutrition without food intake and vitamin supplements.
Cho
Yong Pil
YP
Department of Surgery, University of Ulsan Medical College, Gangneung Asan Hospital, Gangneung-Si, Gangwon-do, Republic of Korea. ypcho@knh.co.kr
Kim
Kwanwoo
K
Han
Myoung Sik
MS
Jang
Hyuk Jai
HJ
Kim
Jee Soo
JS
Kim
Yong Ho
YH
Lee
Sung Gyu
SG
D000140:Acidosis, Lactic / Q000209:etiology* / Q000628:therapy; D005746:Gastric Emptying; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D006435:Renal Dialysis; D013831:Thiamine / Q000008:administration & dosage; D013832:Thiamine Deficiency / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy
D013831:Thiamine