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Updated: Apr 26, 2026

Measuring Lactase Enzymatic Activity in the Teaching Lab
Published on: August 6, 2018
Thiamin Deficiency as a Cause of Persistent Hyperlactatemia in a Parenteral Nutrition-Dependent Patient
Yong Sing Da Silva1, Christopher M Horvat1, Cameron Dezfulian2
1Department of Critical Care, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Background:
Despite the demonstrated dangers of inadequate supplies of injectable multivitamins, periodic shortages of these crucial pharmaceuticals continue to occur in the developed world. This case report provides a recent example of the potential danger of rationing parenteral multivitamins in chronically parenteral nutrition (PN)-dependent patients in the setting of national supply shortages.
Method And Results:
Case report describing a chronically PN-dependent 21-year-old man who presented with signs and symptoms of septic shock to a pediatric intensive care unit at a university hospital. The patient demonstrated hyperlactatemia that persisted following hemodynamic stabilization, and he was determined to be severely deficient in thiamin despite thrice-weekly home multivitamin infusions, instead of daily due to national supply shortages. The patient's hyperlactatemia rapidly resolved following thiamine supplementation.
Conclusion:
Physicians must be vigilant for potentially life-threatening nutrition deficiencies, as illustrated in this case of thiamine insufficiency, in PN-dependent children and adults in the setting of nationwide limitations in multivitamin supply.
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