Lactic Acidosis Secondary to Thiamin Deficiency Following Autologous Stem Cell Transplantation.

Abstract

A 22-month-old female with high-risk neuroblastoma completed 5 cycles of chemotherapy then underwent high-dose chemotherapy with autologous stem cell rescue (ASCR). Parenteral nutrition was administered from day +2 following ASCR, as she was unable to tolerate nasogastric feeds because of grade IV mucositis and vomiting. On day +12, she developed worsening metabolic acidosis with above reportable levels of lactic acid. Given the patient's well clinical appearance and paucity of evidence of end-organ dysfunction on physical examination and on laboratory studies, there was high suspicion that the patient's lactic acidosis did not result from tissue hypoxia and was, in fact, a type B lactic acidosis. Thiamin was empirically administered, with rapid improvement in lactic acidosis. Thiamin deficiency was later confirmed by laboratory studies drawn prior to thiamin administration.

• Authors: Kim R Derespina, Shubhi Kaushik, Kris Mahadeo, Megan McCabe
• Journal: Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition (Nutr Clin Pract) Vol. 36 Issue 2 Pg. 414-418 (Apr 2021) ISSN: 1941-2452 [Electronic] United States
• PMID: 32700422 (Publication Type: Journal Article)
• Copyright: © 2020 American Society for Parenteral and Enteral Nutrition.

Chemical References

• Thiamine

Topics

• Acidosis, Lactic (etiology, therapy)
• Female
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Infant
• Thiamine
• Thiamine Deficiency (etiology)
• Transplantation, Autologous