Cho Yong Pil, Kim Kwanwoo, Han Myoung Sik, Jang Hyuk Jai, Kim Jee Soo, Kim Yong Ho, Lee Sung Gyu
Department of Surgery, University of Ulsan Medical College, Gangneung Asan Hospital, Gangneung-Si, Gangwon-do, Republic of Korea.
Hepatogastroenterology. 2004 Jan-Feb;51(55):253-5.
We encountered a case of total parenteral nutrition-associated lactic acidosis that did not respond to sodium bicarbonate or other conventional emergency treatments. He was characterized by minimal food intake before surgery, delayed gastric emptying after pylorus-preserving pancreatoduodenectomy due to pancreas head cancer and long-term total parenteral nutrition without food intake and vitamin supplements after surgery. After thiamine administration, the patient very quickly recovered with dramatic reestablishment of the acid-base balance. We emphasize the need to supplement total parenteral nutrition with thiamine-containing vitamins for the patients whose food intake does not meet nutritional requirements and to intravenously replenish using high-dose thiamine simultaneously with the manifestation of signs and symptoms of severe lactic acidosis with unknown cause. In conclusion, thiamine deficiency should be included in the differential diagnosis of lactic acidosis for the patients who received total parenteral nutrition without food intake and vitamin supplements.
我们遇到了一例与全胃肠外营养相关的乳酸性酸中毒病例,该病例对碳酸氢钠或其他传统急救治疗均无反应。其特点是术前食物摄入量极少,因胰头癌行保留幽门的胰十二指肠切除术后胃排空延迟,术后长期进行全胃肠外营养且未摄入食物和补充维生素。给予硫胺素后,患者迅速康复,酸碱平衡显著恢复。我们强调,对于食物摄入量未达营养需求的患者,全胃肠外营养需补充含硫胺素的维生素,对于原因不明的严重乳酸性酸中毒且出现体征和症状的患者,应同时静脉补充大剂量硫胺素。总之,对于接受全胃肠外营养且未摄入食物和补充维生素的患者,乳酸性酸中毒的鉴别诊断应包括硫胺素缺乏。