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09 March 2023 : Case report  Bahrain

[In Press] Lactic Acidosis Due to Thiamine Deficiency in a Preterm Infant Associated with Inadequate Parenteral Nutrition

Unusual clinical course, Challenging differential diagnosis

Sara Abdulla Hasan1ADEF, Eman Saleh Shajira1EF

DOI: 10.12659/AJCR.939008

Am J Case Rep In Press; DOI: 10.12659/AJCR.939008  

Available online: 2023-03-09, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Premature low birth weight infants may require prolonged parenteral feeding, which can be associated with deficiencies of vitamins and micronutrients. Deficiency in thiamine (vitamin B1) can result in metabolic crisis and lactic acidosis. This report describes a premature male infant born at 30 weeks of gestation with thiamine deficiency and lactic acidosis associated with inadequate parenteral nutrition.
A preterm boy was born at 30 weeks+5 days, with a weight of 0.830 kilograms and Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. Total parenteral nutrition started on day 1 of life. On day 21 of life, while he was on total parenteral nutrition, severe lactic acidosis with a high anion gap was noted. Sepsis work-up along with radiological studies were immediately done, and antibiotics were initiated to cover common suspected organisms. Repeated blood gas analysis showed further increases in lactate levels. A fluid bolus was administered, with no improvement, so sodium bicarbonate was started. Despite all interventions, the lactate level continued to increase up to 13.78 mmol/l. Thiamine deficiency was suspected next, and a dose of vitamin B1 was given intravenously. There was an immediate drop in lactate level, and the patient proceeded to a full recovery.
This report shows that lactic acidosis is a potentially life-threatening condition that can result from thiamine deficiency. When standard parenteral nutrition preparations are used for prolonged periods in premature neonates, continuous monitoring of vitamin levels, micronutrient levels, and biochemical parameters is required.

Keywords: Aging, Premature; Lactic Acid; Thiamine; Parenteral Nutrition


22 February 2023 : Case report  Taiwan

A 30-Year-Old Woman with an 8-Week History of Anxiety, Depression, Insomnia, and Mild Cognitive Impairment ...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938732  

22 February 2023 : Case report  Nigeria

Multidrug-Resistant Kocuria rosea and Methicillin-Resistant Staphylococcus aureus Co-Infection in a Nigeria...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938761  

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17 Mar 2023 : Case report  USA

Dermoid Cyst of the Parotid Gland: Case Report of a Rare Entity and Review of the Literature

Am J Case Rep In Press; DOI: 10.12659/AJCR.939411  

17 Mar 2023 : Case report  Japan

A Case of a Refractory Bleeding Giant Vaginal Wall Cavernous Hemangioma Successfully Managed with Sclerothe...

Am J Case Rep In Press; DOI: 10.12659/AJCR.939474  

16 Mar 2023 : Case report  Indonesia

Initial Thrombocyte Concentrate Transfusion in Woman with Chronic Immune Thrombocytopenia Purpura (ITP) Who...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938752  

15 Mar 2023 : Case report  USA

Thoracic Epidural as a Rescue Analgesic in a Patient with a Continuous Erector Spinae Plane Block for Rib F...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938875  

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923