Doehn M, Schwartau M, Bause H
Anasth Intensivther Notfallmed. 1983 Apr;18(2):79-80.
Parenteral nutrition with carbohydrates is limited, inter alia, by the occurrence of a dose-dependent hyperlactataemia. Thiamine deficiency, which can be provoked by an eight weeks' diet which is deficient in thiamine, will produce clearly elevated lactate levels in rats, leading eventually to lactate acidosis as a result of glucose load, compared with a control group on a normal diet. It is recommended to initiate a high-dosage level thiamine therapy before parenteral feeding with carbohydrates, if thiamine deficiency appears possible on the grounds of previous history of the case (alcohol abuse) or because of the underlying disease (e.g. oesophageal strictures, carcinoma of the oesophagus).
肠外给予碳水化合物进行营养支持存在诸多限制,其中尤其受到剂量依赖性高乳酸血症发生的限制。硫胺素缺乏可由为期八周的硫胺素缺乏饮食诱发,与正常饮食的对照组相比,这会使大鼠的乳酸水平明显升高,最终因葡萄糖负荷导致乳酸酸中毒。如果根据病例既往史(酗酒)或基础疾病(如食管狭窄、食管癌)判断可能存在硫胺素缺乏,建议在肠外给予碳水化合物营养支持之前启动高剂量硫胺素治疗。