Case ReportMetabolic Acidosis and Thiamine Deficiency
Section snippets
REPORT OF CASE
A 19-year-old woman sought medical advice from her local physician because of a 3-year history of episodic nausea, vomiting, diarrhea, and abdominal pain. Initially, the symptoms had occurred only with her menses and lasted 3 to 5 days. Subsequently, however, the frequency and severity of her symptoms increased to the point that they were almost continuous, and multiple hospitalizations were necessary. Cholecystectomy was performed after a hepatic iminodiacetic acid scan revealed delayed
DISCUSSION
Lactic acidosis is one of the most common causes of an anion gap metabolic acidosis in critically ill patients. It is defined as an acid-base disorder, resulting from the accumulation of lactic acid in body fluids. The diagnosis is made by measurement of the serum or plasma lactate concentration in a patient with an increased anion gap. A plasma lactate concentration of 5 mmol/L or greater is diagnostic. The lactate concentration directly correlates with the severity of illness and the
SUMMARY
Thiamine deficiency can cause significant morbidity and even mortality. Administration of thiamine has an extremely low risk of adverse effects. Health-care providers must have a high index of suspicion and err on the side of thiamine supplementation in order to prevent the complications of deficiency. This case report illustrates three important points: (1) thiamine deficiency should be included in the differential diagnosis of lactic acidosis, (2) patients receiving parenteral nutrition must
References (17)
Lactic acidosis
Kidney Int
(1986)Lactic acidosis
Endocrinol Metab Clin North Am
(1993 Jun)- et al.
Thiamine requirement in the adult human as measured by urinary excretion of thiamine metabolites
J Nutr
(1965) Thiamin. In:
Vitamin deficiency and excess. In:
- et al.
Regulation of the pyruvate dehydrogenase muitienzyme complex
Annu Rev Nutr
(1993) Deaths associated with thiamine-defieient total parenteral nutrition
MMWR Morb Mortal Wkly Rep
(1989)