title: Severe lactic acidosis and thiamine deficiency during total parenteral nutrition--case report.
abstract: 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.
authors.affiliation: Department of Surgery, University of Ulsan Medical College, Gangneung Asan Hospital, Gangneung-Si, Gangwon-do, Republic of Korea. ypcho@knh.co.kr
authors.forename: Yong Pil
authors.initials: YP
authors.lastname: Cho
authors.forename: Kwanwoo
authors.initials: K
authors.lastname: Kim
authors.forename: Myoung Sik
authors.initials: MS
authors.lastname: Han
authors.forename: Hyuk Jai
authors.initials: HJ
authors.lastname: Jang
authors.forename: Jee Soo
authors.initials: JS
authors.lastname: Kim
authors.forename: Yong Ho
authors.initials: YH
authors.lastname: Kim
authors.forename: Sung Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: 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
chemical_list: D013831:Thiamine