Severe Matabolic Acidosis due to Thiamine Deficiency during Intravenous Hyperalimentation : A Case Report and Review of the Literature

An 86-year-old woman, who underwent biliary stenting for bile duct cancer 3 months before, had liver metastasis and was readmitted to our department because of anorexia. Intravenous hyperlimentation (IVH) was administered without vitamin supplementation. Nineteen days after the start of IVH, drowsiness, tachypnea and hypotension with severe metabolic acidosis suddenly manifested. The discontinuation of IVH and the administration of sodium bicarbonate and thiamine corrected the acidosis. Seven days later, IVH with the same contents as the previous one was readministered with daily thiamine supplementation, but no episode similar to the previous one occurred. We daily thiamine supplementation, but no episode similar to the previous one occurred. We believe that severe metabolic acidosis in this patient was due to thiamine deficiency.

Severe metabolic acidosis

Thiamine deficiency

Intravenous hyperalimentation