Lactic Acidosis Secondary to Thiamin Deficiency Following Autologous Stem Cell Transplantation

Kim R. Derespina, Shubhi Kaushik, Kris M. Mahadeo, Megan McCabe

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
JournalNutrition in Clinical Practice
DOIs
StateAccepted/In press - 2020

Keywords

  • lactic acidosis
  • metabolic acidosis
  • parenteral nutrition
  • pediatrics
  • stem cell transplantation
  • thiamin
  • thiamin deficiency

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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