A Case of Lactic Acidosis from Vitamin B₁ Deficiency during Total Parenteral Nutrition

Masaya Nomura, Kazuyasu Nakao, Masaaki Nakahara, Nobuo Ogino, Takeyoshi Yumiba, Satoru Miyazaki, Takashi Emoto, Kazushi Kurozumi, Masashi Narita

Department of Surgery, Osaka Police Hospital

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/l), 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.

Key words
total parenteral nutrition, vitamin B₁ deficiency, lactic acidosis

Reprint requests
Masaya Nomura Department of Surgery, Osaka Police Hospital
10-31 Kitayamacho, Tennoujiku, Osaka, 543 JAPAN

Accepted
September 11, 1996

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