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Lactic Acidosis Secondary to Thiamin Deficiency Following Autologous Stem Cell Transplantation

CRITICAL CARE MEDICINE(2021)

Cited 3|Views15
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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.
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Key words
lactic acidosis,metabolic acidosis,parenteral nutrition,pediatrics,stem cell transplantation,thiamin,thiamin deficiency
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