Severe lactic acidosis and thiamin deficiency during parenteral nutrition in a child.

We report the case of a leukemic child treated with chemotherapy and parent eral nutrition for three weeks, who developed a severe lactic acidosis. Cli nical features included both digestive and neurological disorders associate d with a moderate cardiovascular collapse. After elimination of a toxic, a neoplastic or a septic cause, a thiamin (or vitamin B1) deficiency was susp ected because of the lack of vitamin supply to parenteral nutrition. Intrav enous administration of thiamin rapidly controlled lactic and clinical feat ures. The diagnosis was confirmed by a low plasmatic concentration of thiam in. Thiamin deficiency must be suspected in case of severe lactic acidosis during parenteral nutrition and systematically prevented by supply of vitam ins. (C) 1999 Elsevier, Paris.