A case of lactic acidosis caused by thiamine deficiency / 대한내과학회지

ABSTRACT

Lactic acidosis commonly occurs in association with shock. We encountered lactic acidosis in a patient with normal blood pressure. The patient was a 17 year-old man with acute lymphocytic leukemia. He was admitted for bone marrow transplantation. During hospitalization, he relied on total parenteral nutrition due to his poor oral intake. On the 37th day after admission, he developed lactic acidosis without an episode of hypotension or any causative medication. Because vitamins were not included in the parenteral nutrition, we prescribed thiamine replacement, and this corrected the acidosis within a few hours. Thiamine (in its active derivative) is a coenzyme for pyruvate dehydrogenase; thus, its deficiency causes accumulation of pyruvate and lactate. This case suggests that thiamine deficiency should be included in a differential diagnosis of lactic acidosis in patients who are on total parenteral nutrition without vitamin supplementation.