[Life-threatening lactic acidosis during total parenteral nutrition. Successful therapy with thiamine]

Two patients, 37 and 44 years old, respectively, developed severe metabolic acidosis after abdominal surgery which was followed by three weeks of total parenteral nutrition. Septicaemia, peritonitis or hypoxia were excluded as possible causes. Both patients had very high serum lactate concentrations (24.3 and 22.8 mmol/l, respectively). Conventional treatment with buffer agents was unsuccessful. Because vitamin B1 deficiency was suspected, two doses of 400 mg thiamine were administered. In both patients the extreme lactic acidosis disappeared immediately after the injections. Both patients were later discharged without any symptoms.