he study describes a 19-year-old patient who was
receiving home parenteral nutrition, in whom lactic
acidosis developed. A review of her home parenteral
nutrition formula revealed the absence of multivitamins,
most significantly thiamine. After thiamine administration,
the acidosis resolved, and the patient experienced
pronounced clinical improvement. Clinicians must be
aware that thiamine is essential for normal glucose
metabolism and that thiamine deficiency can lead to lactic
acidosis. Thiamine should be included in the differential
diagnosis of lactic acidosis. The recent shortage of
intravenous multivitamin preparations has led to
documented cases of lactic acidosis as a result of
thiamine deficiency, and a previous shortage led several
deaths due to lactic acidosis as a consequence of
thiamine deficiency. All patients receiving parenteral
nutrition must also receive adequate vitamin
supplementation.
SA Romanski, MM McMahon, Mayo Clinic Proc 1999;74:259-
263
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