Severe Lactic Acidosis in a Critically Ill Child: Think About Thiamine! A Case Report

Area of Science:

• Biochemistry
• Pediatric Critical Care
• Nutritional Science

Background:

• Leukemia patients undergoing chemotherapy are at risk for nutritional deficiencies.
• Parasitic infections can complicate management and increase nutritional demands.
• Severe illness can precipitate metabolic derangements, including lactic acidosis.

Observation:

• A teenage leukemia patient on maintenance chemotherapy presented with parasitic infection and required parenteral nutrition.
• The patient developed refractory shock, necessitating extracorporeal membrane oxygenation.
• Despite hemodynamic support, worsening lactic acidosis persisted until thiamine administration.

Findings:

• Thiamine supplementation led to rapid normalization of lactic acidosis within 12 hours.
• Thiamine is a crucial coenzyme for aerobic glycolysis; deficiency impairs this pathway.
• Lactate accumulation occurred due to a shift towards anaerobic glycolysis secondary to thiamine deficiency.

Implications:

• Thiamine deficiency should be considered in pediatric patients with unexplained lactic acidosis, especially those with risk factors.
• Early recognition and supplementation of thiamine can be life-saving in critically ill children.
• This case underscores the importance of comprehensive nutritional assessment and management in immunocompromised pediatric patients.