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KMID : 0882420070730040443
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Korean Journal of Medicine
2007 Volume.73 No. 4 p.443 ~ p.447
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A case of lactic acidosis caused by thiamine deficiency
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Byun Seung-Woon
Choi Seong-Ho
Park Hyun-Gu
Kim Beom-Jun
Kim Eui-Young
Lee Kyoo-Hyung
Yang Won-Seok
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Abstract
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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
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KEYWORD
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Lactic acidosis, Thiamine deficiency, Total parenteral nutrition
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