Premium
Thiamin Deficiency as a Cause of Persistent Hyperlactatemia in a Parenteral Nutrition–Dependent Patient
Author(s) -
Da Silva Yong Sing,
Horvat Christopher M.,
Dezfulian Cameron
Publication year - 2015
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607114545128
Subject(s) - hyperlactatemia , medicine , multivitamin , parenteral nutrition , economic shortage , intensive care medicine , thiamine , beriberi , septic shock , pediatrics , sepsis , surgery , vitamin , anesthesia , linguistics , philosophy , government (linguistics)
Background: Despite the demonstrated dangers of inadequate supplies of injectable multivitamins, periodic shortages of these crucial pharmaceuticals continue to occur in the developed world. This case report provides a recent example of the potential danger of rationing parenteral multivitamins in chronically parenteral nutrition (PN)–dependent patients in the setting of national supply shortages. Method and Results: Case report describing a chronically PN‐dependent 21‐year‐old man who presented with signs and symptoms of septic shock to a pediatric intensive care unit at a university hospital. The patient demonstrated hyperlactatemia that persisted following hemodynamic stabilization, and he was determined to be severely deficient in thiamin despite thrice‐weekly home multivitamin infusions, instead of daily due to national supply shortages. The patient's hyperlactatemia rapidly resolved following thiamine supplementation. Conclusion: Physicians must be vigilant for potentially life‐threatening nutrition deficiencies, as illustrated in this case of thiamine insufficiency, in PN‐dependent children and adults in the setting of nationwide limitations in multivitamin supply.