2 CASES OF THIAMINE DEFICIENCY-INDUCED LACTIC-ACIDOSIS DURING TOTAL PARENTERAL-NUTRITION

Two cases of severe lactic acidosis induced by total parenteral nutrit ion (TPN) are reported. Both cases were admitted to our department for the surgical treatment of advanced gastric cancer, and subsequently u nderwent TPN because of poor nutritional status. Following the initiat ion of TPN, both patients went into an unstable circulatory state foll owing shock. Both cases showed signs of peritonitis, suggestive of an intraabdominal abscess, and subsequently underwent an emergency laparo tomy to explore the origin of the lactic acidosis. There was, however, no apparent infectious focus which would lead to severe metabolic aci dosis in the abdominal cavity. One case died of irreversible shock. Th e other case similarly exhibited a deteriorated cardiovascular state b ut promptly responded to the administration of thiamine and was resusc itated. The blood thiamine level was low in both individuals, and the two patients were subsequently diagnosed as having thiamine deficiency -induced lactic acidosis.