Severe Lactic Acidosis Due to Thiamine Deficiency in a Patient with B-Cell Leukemia/Lymphoma on Total Parenteral Nutrition during High-Dose Methotrexate Therapy

Johanna Svahn, Maria Cristina Schiaffino, Ubaldo Caruso, Michaela Calvillo, Giuseppe Minniti, Carlo Dufour

Research output: Contribution to journalArticle

Abstract

An 11-month-old girl with B-cell leukemia/lymphoma developed profound lethargy due to severe lactic acidosis during chemotherapy and total parenteral nutrition (TPN). Initial treatment with NaHCO3 was ineffective. Treatment with a vitamin cocktail (OH-cobalamin, pyridoxine, thiamine, riboflavine, biotin, carnitine) at pharmacologic doses rapidly improved the child's clinical and laboratory status. Lactic acidosis was caused by an impairment of pyruvate dehydrogenase complex, which was due to lack of its necessary cofactor thiamine in the TPN. This case report indicates that lactic acidosis may be a front-line diagnosis in patients on TPN with lethargy and outlines the need for monitoring thiamine supply in TPN.

Original languageEnglish
Pages (from-to)965-968
Number of pages4
JournalJournal of Pediatric Hematology/Oncology
Volume25
Issue number12
DOIs
Publication statusPublished - Dec 2003

Keywords

  • High-dose methotrexate therapy
  • Lactic acidosis
  • Leukemia
  • Lymphoma
  • Thiamine deficiency
  • Total parenteral nutrition

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Oncology
  • Hematology

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