Efficacy of hemodiafiltration in a child with severe lactic acidosis due to thiamine deficiency

We report the case of a child in whom severe lactic acidosis (LA) and hyper ammonemia developed after twenty days of total parenteral nutrition (TPN) f or diffuse esophageal damage due to caustic ingestion. The revision of TPN preparation revealed that thiamine was never included and the hypothesis of thiamine deficiency was later confirmed measuring the serum thiamine level . Because severe metabolic acidosis the dialytic treatment with hemodiafilt ration (HDF) and bicarbonate infusion were performed: the patient very quic kly recovered with dramatic reestablishment of the acid-basic balance. Thia mine administration restored lactate metabolism. We emphasize that HDF is a useful and prompt treatment for LA to get over the critical phase of neuro logical and cardiological damage.