The authors report a case of severe lactic acidosis in a 3-year-old boy, after 20 days of total parenteral nutrition without vitamin supplementation. This child with acute lymphoblastic leukemia underwent a period of severe refractory lactic acidosis (pH between 6.81 and 7.00 and a serum lactate level up to 38 mmol/liter) leading to cardiac arrest. After the initial resuscitation and the subsequent treatment of shock and vitamin K deficiency, acute peritoneal dialysis was instituted to correct the severe lactic acidosis. Initial low plasma thiamine levels confirmed the diagnosis of thiamine deficiency. An associated transient pancreatic dysfunction was also noted. The patient's overall course with thiamine replacement therapy led to a complete recovery within 5 days and no sequelae were noted after 12 months. (Journal of Parenteral and Enteral Nutrition15:105-109, 1991)
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References
1.
Blennow G.: Wernicke encephalopathy following prolonged artificial nutrition. Am J Dis Child129:1456-1460, 1975
Baughman FA, Jr, Papp JP: Wernicke's encephalopathy with intravenous hyperalimentation: Remarks on similarities between Wernicke's encephalopathy and the phosphate-depletion syndrome. Mt Sinai J Med43:48-52, 1976
Glaser P.: Encéphalopathie de Wernicke et nutrition parentérale en chirurgie digestive. Quatriene symposium international de nutrition artificielle. Luxembourg, Belgium, Meducation Service Hoeckst, June 9-11, 1978, pp 553-559
6.
Harper CG: Sudden, unexpected death and Wernicke's encephalopathy : A complication of prolonged intravenous feeding. Aust NZ J Med10:230-235, 1980
7.
Guerrero RM: Wernicke's syndrome due to vitamin B deficiency: Report of the disease in two infants. Am J Dis Child78:88-96, 1949
8.
King JF, Easton R., Dunn M.:. Acute pernicious beriberi heart disease. Chest61:512-514, 1972
9.
Attas M., Hauley HG, Stultz D., et al: Fulminant beriberi heart disease with lactic acidosis: Presentation of a case with evaluation of left ventricular function and review of pathophysiologic mechanisms. Circulation58:566-572, 1978
10.
Thirunavukkarasu K.: Treatment of alcoholic lactic acidosis. Med J Aust2:583-584, 1979
11.
Fond B., Richard C., Comoy E., et al: Two cases of shoshin beriberi with hemodynamic and plasma cetecholamine data. Int Care Med6:193-198, 1980
12.
Campbell Ch : The severe lactic acidosis of thiamine deficiency: Acute pernicious or fulminating beriberi. Lancet2:446-449, 1984
13.
Teyssier G. : Carbohydrate infusion inducing lactic acidosis. Role of thiamine deficiency in an infant with malnutrition. Press Med15:120-121, 1986
14.
Sandubray J-M. , Barbier M-L.: Thiamine. IN Les vitamines , Munnich A, Ogier M, Sandubray J-M (eds). Masson, Paris, 1987, pp 107-142
15.
Velez RJ, Myers B., Guber MS: Severe acute metabolic acidosis (acute beriberi): An avoidable complication of total parenteral nutrition. JPEN9:216-219, 1985
16.
Lehninger AL : Biochemistry. Worth Publishers , New York, 1978, pp 450-453
17.
Stryer L.: Biochemistry. Freeman, New York , 1988, pp 379-383
18.
Field M., Block JB, Levin R., et al: Significance of blood lactate elevations among patients with acute leukemia and other neoplastic proliferative disorders. Am J Med40:528-547, 1966
19.
Cohen RD, Wood HF: Clinical and biochemical aspects of lactic acidosis. Blackwell , Oxford, 1976
20.
Schlichtig R. , Ayres, SM: Nutritional support of the critically ill . Yearbook Medical Publishers, Chicago, 1988
21.
Kreisberg RA : Lactate hemeostasis and lactic acidosis. Ann Int Med92:227-237, 1980
22.
Campbell Ch : The myth of spontaenous idiopathic lactic acidosis . Aust NZ J Med15:771, 1985
23.
Kruse JA, Carlson RW: Lactate metabolism. Crit Care Clin3:725-746, 1987
24.
Goldsmith GA : The blood lactate-pyruvate relationship in various physiologic and pathologic states. Am J Med Sci245:182-188, 1948
25.
Buckle RM: Blood pyruvic and ketoglutaric acids in thiamine deficiency. Metabolism14:141-149, 1965
26.
Haljamae H. :. Lactate metabolism. Int Care World4:118-121, 1987
27.
Dalgleish AG : Lactic acidosis of thiamine deficiency. Lancet2:644, 1984
28.
Cederbaum SD , Blass JP, Minkoff N., et al: Sensitivity to carbohydrate in a patient with familial intermittent lactic acidosis and pyruvate dehydrogenase deficiency . Pediatr Res10:713-720, 1976
29.
Leonard JV: Problems in the congenital lactic acidosis. IN Metabolic acidosis . Ciba Foundation Symposium, Pitman, London, 1982
30.
Rathanaswami P., Sundaresan R.: Effects of insulin secretagogues on the secretion of insulin during thiamine deficiency. Biochem Int17:523-528, 1988
31.
Vieregge P. : Diabetic coma and Wernicke-Korsakoff syndrome . Fortschr Neurol Psychiatr55:130-139, 1987
32.
Ziporin ZZ, Nunes WT, Powell RC: Thiamine requirement in the adult human as measured by urinary excretion of thiamine metabolites. J Nutr85:297-304, 1965
33.
Vaziri ND, Ness R., Wellikson L., et al: Bicarbonate-buffered peritoneal dialysis: An effective adjunct in the treatment of lactic acidosis. Am J Med67:392-396, 1979
34.
Nash MA, Russo JC: Neonatal lactic acidosis and renal failure: The role of peritoneal dialysis . J Pediatr91:101-105, 1977
35.
Naparstek Y. , Friedlaender MM, Rubinger D., et al: Lactic acidosis and peritoneal dialysis . Isr J Med Sci18:513-514, 1982
36.
Ross EA, Nissenson AR: Acid-base and electrolyte disturbances. IN Handbook of dialysis , Dangirdas JT, Ing TS (eds). Little, Brown, Boston , 1988, pp 307-308
37.
Woods HLF, Connor H., Tucker GT: The role of altered lactate kinetics in the pathogenesis of type B lactic acidosis. IN Metabolic acidosis, Ciba Foundation Symposium, Pitman, London. 1982
38.
Cohen RD: Pathophysiology of lactic acidosis. IN Update in intensive care and emergency medicine. Springer-Verlag, Berlin , 1988, pp 40-43
39.
Knochel JP: The pathophysiology and clinical characteristics of severe hypophosphatemia . Arch Int Med137:203-220, 1977
40.
Ricour C.: Techniques et indications de la nutrition parenterale exclusive chez l'enfant . Rev Prat35:1105-1113, 1985
