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BMJ Case Reports 2014; doi:10.1136/bcr-2014-205264
  • CASE REPORT

Severe lactic acidosis and multiorgan failure due to thiamine deficiency during total parenteral nutrition

  1. Natalie Pageler1
  1. 1Department of Pediatric Critical Care, Stanford University, Palo Alto, California, USA
  2. 2Department of Pediatric Pharmacy, Stanford University, Palo Alto, California, USA
  3. 3Department of Pediatric Surgery, Stanford University, Palo Alto, California, USA
  1. Correspondence to Dr Musaab Ramsi, musaab.ali{at}gmail.com
  • Accepted 8 May 2014
  • Published 3 June 2014

Summary

A 16-year-old perioperative paediatric patient presented with refractory lactic acidosis and multiorgan failure due to thiamine-deficient total parenteral nutrition during a recent national multivitamin shortage. Urgent empiric administration of intravenous thiamine resulted in prompt recovery from this life-threatening condition. Despite readily available treatment, a high index of suspicion is required to prevent cardiovascular collapse and mortality.

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