[Thiamine deficiency associated with parenteral nutrition: apropos of a new case]. / Déficit de tiamina asociado a nutrición parenteral: a propósito de un nuevo caso.

In thiamine deficiency, the Krebs cycle slows large quantities of pyruvate are diverted to lactate production and anaerobic metabolism begins. The most frequent cause of this syndrome is a dietary deficiency associated to a greater or lesser degree with alcoholism. Other less frequent causes are the ingestion of raw fish contaminated with microbial thiaminases, inborn errors of metabolism and total parenteral nutrition. We present the clinical case of a patient with an acute thiamine deficiency after 15 days of total parenteral nutrition, which improved with intravenous administration of thiamine. The incidence of beriberi among patients undergoing total parenteral nutrition is very low because of the almost systematic addition of vitamin complexes. Our patient's clinical picture was sudden, corresponding to the dry form, with typical neurological symptoms and signs, major metabolic acidosis, hyperglycemia and hyponatremia. The clinical response to the administration of thiamine confirmed the diagnosis.

[The glycemic response to a test breakfast of an enteral diet with fiber and a high starch content in diabetics treated with insulin and oral antidiabetics]. / Respuesta glucémica a un desayuno de prueba con una dieta enteral con fibra y alto contenido en almidón en diabéticos tratados con insulina y antidiabéticos orales.

An enteral nutrition preparation appeared recently on the Spanish market specifically for diabetic patients. It is a normocaloric and normoproteic formula of low osmolarity, rich in soluble fibre and slow-absorption carbohydrates such as fructose and starch, following the classic norms of the American Diabetics Association. The glycemic response was examined at 0, 30, 60 and 120 minutes following the ingestion of 250 cc of Precitene Diabet as breakfast for 40 diabetic patients, half treated with oral antidiabetic substances (DMado) and the other half with insulin (DMins). In both groups, the greatest glycemic increase was at 60 minutes. In the DMado patients, the increase at 60 minutes (70 mg/dl) was not significantly different from that considered by Skyler as acceptable. The same occurred at 120 minutes (40 mg/dl). In the DMins patients, the glycemic increase at 60 minutes was 27 +/- 29 mg/dl, more than that considered acceptable by Skyler (p 0.0006). After 120 minutes this difference was also greater than the acceptable level, by 41 +/- 38 mg/dl (p 0.0002). In conclusion, it may be considered that, for DMado patients, glycemic control remains within the postprandial limits considered to be "acceptable" so that no treatment modification is felt necessary in the administration of enteral nutrition with Precitene Diabet. The glycemic response in the DMins patients was higher than "acceptable", calling for rapid insulin supplements to their habitual NPH insulin doses.