title: Thiamin Deficiency as a Cause of Persistent Hyperlactatemia in a Parenteral Nutrition-Dependent Patient.
abstract: BACKGROUND
  Despite the demonstrated dangers of inadequate supplies of injectable multivitamins, periodic shortages of these crucial pharmaceuticals continue to occur in the developed world. This case report provides a recent example of the potential danger of rationing parenteral multivitamins in chronically parenteral nutrition (PN)-dependent patients in the setting of national supply shortages.
  
  
  RESULTS
  Case report describing a chronically PN-dependent 21-year-old man who presented with signs and symptoms of septic shock to a pediatric intensive care unit at a university hospital. The patient demonstrated hyperlactatemia that persisted following hemodynamic stabilization, and he was determined to be severely deficient in thiamin despite thrice-weekly home multivitamin infusions, instead of daily due to national supply shortages. The patient's hyperlactatemia rapidly resolved following thiamine supplementation.
  
  
  CONCLUSIONS
  Physicians must be vigilant for potentially life-threatening nutrition deficiencies, as illustrated in this case of thiamine insufficiency, in PN-dependent children and adults in the setting of nationwide limitations in multivitamin supply.
authors.affiliation: Department of Critical Care, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Yong Sing
authors.initials: YS
authors.lastname: Da Silva
authors.affiliation: Department of Critical Care, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Horvat
authors.affiliation: Department of Critical Care, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania dezfulianc@upmc.edu.
authors.forename: Cameron
authors.initials: C
authors.lastname: Dezfulian
mesh_terms: D000328:Adult; D019587:Dietary Supplements; D006801:Humans; D065906:Hyperlactatemia / Q000097:blood / Q000209:etiology*; D007362:Intensive Care Units; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D013831:Thiamine / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use; D013832:Thiamine Deficiency / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D014803:Vitamin B Complex / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014803:Vitamin B Complex; D013831:Thiamine
keywords: dietary supplements; lactic acidosis; parenteral nutrition; sepsis; thiamin deficiency