A case of lactic acidosis from vitamin B1 deficiency during total parenteral nutrition

Abstract:: We report the case of an 86-year-old woman who received thermochemotherapy for advanced pancreatic cancer. She was given total parenteral nutrition (TPN) without vitamins because of decreaed food intake. Clouding of consciousness, peripheral circulatory failure, tachypnea and abdominal pain occurred suddenly 21 days after the start of TPN. Arterial blood gas analysis revealed severe metabolic acidosis (pH 7.193, base excess -16.6 mEq/1), which was refractory to the administration of sodium bicarbonate. After the administration of 150 mg of thiamine intravenously, the level of consciousness and the severe acidosis were improved. The levels of serum lactate and blood vitamin B1 at the onset were 119 mg/dl (normal range: 4-16) and 13 ng/ml (normal range: 25-50), respectively, and improved rapidly after thiamine therapy.

Authors:: M Nomura, K Nakao, M Nakahara, N Ogino, T Yumiba, S Miyazaki, T Emoto, K Kurozumi, M Narita

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