Oriot D, Wood C, Gottesman R, Huault G
Division of Pediatric Intensive Care, Montreal Children's Hospital, Quebec, Canada.
JPEN J Parenter Enteral Nutr. 1991 Jan-Feb;15(1):105-9. doi: 10.1177/0148607191015001105.
The authors report a case of severe lactic acidosis in a 3-year-old boy, after 20 days of total parenteral nutrition without vitamin supplementation. This child with acute lymphoblastic leukemia underwent a period of severe refractory lactic acidosis (pH between 6.81 and 7.00 and a serum lactate level up to 38 mmol/liter) leading to cardiac arrest. After the initial resuscitation and the subsequent treatment of shock and vitamin K deficiency, acute peritoneal dialysis was instituted to correct the severe lactic acidosis. Initial low plasma thiamine levels confirmed the diagnosis of thiamine deficiency. An associated transient pancreatic dysfunction was also noted. The patient's overall course with thiamine replacement therapy led to a complete recovery within 5 days and no sequelae were noted after 12 months.
作者报告了一例3岁男孩在接受20天完全胃肠外营养且未补充维生素后发生严重乳酸酸中毒的病例。这名患有急性淋巴细胞白血病的儿童经历了一段严重的难治性乳酸酸中毒期（pH值在6.81至7.00之间，血清乳酸水平高达38 mmol/升），最终导致心脏骤停。在最初的复苏以及随后对休克和维生素K缺乏的治疗后，进行了急性腹膜透析以纠正严重的乳酸酸中毒。最初血浆硫胺素水平较低，证实了硫胺素缺乏的诊断。还发现了相关的短暂胰腺功能障碍。患者接受硫胺素替代治疗后的总体病程导致在5天内完全康复，12个月后未发现后遗症。
