Severe metabolic acidosis and heart failure due to thiamine deficiency

We report the case of a male patient with severe metabolic acidosis and hea rt failure caused by thiamine deficiency. He was admitted in August 1998 to the Tokai University Oiso Hospital because of severe dyspnea. The patient was diagnosed with heart failure and metabolic acidosis of unknown causes b ased on arterial blood gas analysis, chest x ray, and ultrasonic echocardio graphic examinations. Our previous experience in treating a patient with th iamine deficiency caused by total parenteral nutrition without thiamine sup plementation suggested that this patient was deficient in thiamine. The ser um thiamine Level was low and the lactate level was high. After intravenous administration of thiamine, the acidosis and heart failure disappeared. Di etary analysis showed that thiamine intake was low (0.32 mg/1000 kcal/d). T hiamine deficiency should be included in the differential diagnosis when en countering cases of heart failure with severe metabolic acidosis, even in d eveloped countries. (C) Elsevier Science Inc. 2001.