| Clinical and biochemical aspects of thiamine treatment for metabolic acidosis during total parenteral nutrition. | |
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MedLine Citation:
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PMID: 9106788 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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We encountered six cases of total parenteral nutrition (TPN)-associated lactic acidosis during the 6-y period of 1988-1993. The patients were characterized by severe disease of the digestive organs, minimal food intake before surgery, and postoperative TPN with no food intake and with no vitamin supplements. Within 4 wk of TPN, they developed hypotension (< or = 80/60 mmHg), Kussmaul's respiration, and clouding of consciousness, as well as abdominal pain not directly related to the underlying disease. Routine laboratory examinations revealed no acute aggravation in hepatic, renal, or pancreatic functions. Arterial blood gas analysis showed pH < or = 7.134 and base excess < or = -17.5 mmol/L. Additional laboratory examinations revealed serum lactate > or = 10.9 mmol/L, serum pyruvate > or = 159 mumol/L, and lactate/pyruvate ratio > or = 0.029. None of the patients responded to sodium bicarbonate or other conventional emergency treatments for shock and lactic acidosis. After the first case, we suspected that thiamine deficiency might be responsible for this pathologic condition, Serum thiamine was proved to be < or = 196 nmol/L in 5 patients. Thiamine replenishment at intravenous doses of 100 mg every 12 h resolved lactic acidosis and improved the clinical condition in 3 patients. This article includes a review of 11 relevant reports published from 1982-1992 and a discussion of the biochemical mechanism of onset of thiamine deficiency-associated lactic acidosis. We emphasize the needs (1) to supplement TPN with thiamine-containing vitamins for the patients whose food intake does not meet nutritional requirements; (2) to monitor the patients routinely measuring serum thiamine concentration and erythrocyte transketolase activity during TPN; and (3) to intravenously replenish using high-dose thiamine simultaneously with the manifestation of signs and symptoms of lactic acidosis. |
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Authors:
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H Nakasaki; M Ohta; J Soeda; H Makuuchi; M Tsuda; T Tajima; T Mitomi; K Fujii |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Nutrition (Burbank, Los Angeles County, Calif.) Volume: 13 ISSN: 0899-9007 ISO Abbreviation: Nutrition Publication Date: 1997 Feb |
Date Detail:
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Created Date: 1997-06-12 Completed Date: 1997-06-12 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8802712 Medline TA: Nutrition Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 110-7 Citation Subset: IM |
Affiliation:
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Department of Surgery, Tokai University Oiso Hospital, Kanagawa, Japan. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acidosis, Lactic
/
diagnosis,
drug therapy*,
etiology* Adult Aged Female Humans Male Middle Aged Parenteral Nutrition, Total / adverse effects* Thiamine / administration & dosage, therapeutic use* Thiamine Deficiency / complications* |
| Chemical | |
Reg. No./Substance:
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59-43-8/Thiamine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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