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Baldo F, Drago E, Nisticò D, Buratti S, Calvillo M, Micalizzi C, Schiaffino MC, Maghnie M. Severe Lactic Acidosis Caused by Thiamine Deficiency in a Child with Relapsing Acute Lymphoblastic Leukemia: A Case Report. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1602. [PMID: 37892265 PMCID: PMC10605394 DOI: 10.3390/children10101602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/16/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023]
Abstract
Lactic acidosis is characterized by an excessive production of lactic acid or by its impaired clearance. Thiamine deficiency is an uncommon cause of lactic acidosis, especially in countries where malnutrition is rare. We describe the case of a 5-year-old boy who presented with a central nervous system relapse of acute lymphoblastic leukemia. During the chemotherapy regimen, the patient developed drug-induced pancreatitis with paralytic ileus requiring prolonged glucosaline solution infusion. In the following days, severe lactic acidosis (pH 7.0, lactates 253 mg/dL, HCO3- 8 mmol/L) was detected, associated with hypoglycemia (42 mg/dL) and laboratory signs of acute liver injury. Due to the persistent hypoglycemia, the dextrose infusion was gradually increased. Lactates, however, continued to raise, so continuous venovenous hemodiafiltration was started. While lactates initially decreased, 12 h after CVVHDF suspension, they started to raise again. Assuming that it could have been caused by mitochondrial dysfunction due to vitamin deficiency after prolonged fasting and feeding difficulties, parenteral nutrition and thiamine were administered, resulting in a progressive reduction in lactates, with the normalization of pH during the next few hours. In the presence of acute and progressive lactic acidosis in a long-term hospitalized patient, thiamine deficiency should be carefully considered and managed as early as possible.
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Affiliation(s)
- Francesco Baldo
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Enrico Drago
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16147 Genoa, Italy
| | - Daniela Nisticò
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Silvia Buratti
- Neonatal and Pediatric Intensive Care Unit, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | | | | | | | - Mohamad Maghnie
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16147 Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Giannina Gaslini, 16147 Genoa, Italy
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2
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Zhang X, Arnone V, Ackerman K, Al-issa F. Vertigo-Associated Vomiting: Acute Presentation of Thiamine Deficiency in Intestinal Failure. JPGN REPORTS 2022; 3:e226. [PMID: 37168633 PMCID: PMC10158385 DOI: 10.1097/pg9.0000000000000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/16/2022] [Indexed: 05/13/2023]
Abstract
Thiamine deficiency can manifest as Wernicke encephalopathy, with the classic clinical triad of altered mental status, nystagmus, and ataxia. Although a rare diagnosis in pediatric patients within developed countries, gastrointestinal disorders that impair nutritional intake and absorption can place patients at higher risk. Rapid diagnosis and early empiric treatment of Wernicke encephalopathy is paramount due to high risk of mortality and long-term morbidity. We present a patient with intestinal failure who developed thiamine deficiency following weaning off parenteral nutrition with acute onset of vertigo-associated vomiting. In the absence of consensus guidelines for treatment dosing and duration, in both adult and pediatric populations, we review prior pediatric cases and propose a strategy for dosing with symptom-guided step-up approach to maximize treatment efficacy in a time-conscious manner.
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Affiliation(s)
- Xiaoyi Zhang
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Vincent Arnone
- West Virginia University, School of Medicine, Department of Neurology, Morgantown, WV
| | - Kimberly Ackerman
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Feras Al-issa
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, PA
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Guiducci S, Duci M, Moschino L, Meneghelli M, Fascetti Leon F, Bonadies L, Cavicchiolo ME, Verlato G. Providing the Best Parenteral Nutrition before and after Surgery for NEC: Macro and Micronutrients Intakes. Nutrients 2022; 14:919. [PMID: 35267894 PMCID: PMC8912377 DOI: 10.3390/nu14050919] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/18/2022] Open
Abstract
Necrotizing enterocolitis (NEC) is the main gastrointestinal emergency of preterm infants for whom bowel rest and parenteral nutrition (PN) is essential. Despite the improvements in neonatal care, the incidence of NEC remains high (11% in preterm newborns with a birth weight <1500 g) and up to 20−50% of cases still require surgery. In this narrative review, we report how to optimize PN in severe NEC requiring surgery. PN should begin as soon as possible in the acute phase: close fluid monitoring is advocated to maintain volemia, however fluid overload and electrolytes abnormalities should be prevented. Macronutrients intake (protein, glucose, and lipids) should be adequately guaranteed and is essential in each phase of the disease. Composite lipid emulsion should be the first choice to reduce the risk of parenteral nutrition associated liver disease (PNALD). Vitamin and trace elements deficiency or overload are frequent in long-term PN, therefore careful monitoring should be planned starting from the recovery phase to adjust their parenteral intake. Neonatologists must be aware of the role of nutrition especially in patients requiring long-term PN to sustain growth, limiting possible adverse effects and long-term deficiencies.
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Affiliation(s)
- Silvia Guiducci
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (S.G.); (L.M.); (M.M.); (L.B.); (M.E.C.)
| | - Miriam Duci
- Pediatric Surgery Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (M.D.); (F.F.L.)
| | - Laura Moschino
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (S.G.); (L.M.); (M.M.); (L.B.); (M.E.C.)
| | - Marta Meneghelli
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (S.G.); (L.M.); (M.M.); (L.B.); (M.E.C.)
| | - Francesco Fascetti Leon
- Pediatric Surgery Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (M.D.); (F.F.L.)
| | - Luca Bonadies
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (S.G.); (L.M.); (M.M.); (L.B.); (M.E.C.)
| | - Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (S.G.); (L.M.); (M.M.); (L.B.); (M.E.C.)
| | - Giovanna Verlato
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (S.G.); (L.M.); (M.M.); (L.B.); (M.E.C.)
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Rakotoambinina B, Hiffler L, Gomes F. Pediatric thiamine deficiency disorders in high-income countries between 2000 and 2020: a clinical reappraisal. Ann N Y Acad Sci 2021; 1498:57-76. [PMID: 34309858 PMCID: PMC9290709 DOI: 10.1111/nyas.14669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/21/2021] [Accepted: 07/05/2021] [Indexed: 12/20/2022]
Abstract
Often thought to be a nutritional issue limited to low- and middle-income countries (LMICs), pediatric thiamine deficiency (PTD) is perceived as being eradicated or anecdotal in high-income countries (HICs). In HICs, classic beriberi cases in breastfed infants by thiamine-deficient mothers living in disadvantaged socioeconomic conditions are thought to be rare. This study aims to assess PTD in HICs in the 21st century. Literature searches were conducted to identify case reports of PTD observed in HICs and published between 2000 and 2020. The analyzed variables were age, country, underlying conditions, clinical manifestations of PTD, and response to thiamine supplementation. One hundred and ten articles were identified, totaling 389 PTD cases that were classified into four age groups: neonates, infants, children, and adolescents. Eleven categories of PTD-predisposing factors were identified, including genetic causes, lifestyle (diabetes, obesity, and excessive consumption of sweetened beverages), eating disorders, cancer, gastrointestinal disorders/surgeries, critical illness, and artificial nutrition. TD-associated hyperlactatemia and Wernicke encephalopathy were the most frequent clinical manifestations. The circumstances surrounding PTD in HICs differ from classic PTD observed in LMICs and this study delineates its mutiple predisposing factors. Further studies are required to estimate its magnitude. Awareness is of utmost importance in clinical practice.
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Affiliation(s)
- Benjamin Rakotoambinina
- Cellular Nutrition Research GroupLagny sur MarneFrance
- LRI Isotopic Medicine Physiology LabUniversity of AntananarivoAntananarivoMadagascar
| | | | - Filomena Gomes
- The New York Academy of SciencesNew YorkNew York
- NOVA Medical SchoolUniversidade NOVA de LisboaLisboaPortugal
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Huang AC, Herdes RE, Yamin G, Kerner J. An Unusual Case of Thiamine Deficiency in a Total Parenteral Nutrition-Dependent Child Secondary to Munchausen by Proxy. JPGN REPORTS 2021; 2:e044. [PMID: 37206950 PMCID: PMC10191465 DOI: 10.1097/pg9.0000000000000044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/10/2020] [Indexed: 05/21/2023]
Affiliation(s)
- Alice C. Huang
- From the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Rachel E. Herdes
- From the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Ghiam Yamin
- Department of Radiology, Lucile Packard Children’s Hospital, Palo Alto, CA
| | - John Kerner
- From the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Lucile Packard Children’s Hospital, Palo Alto, CA
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Zhang Y, Zhou B, Wu L, Cao H, Xie G, Fang H. Short Bowel Syndrome in an Extremely Low Birth Weight Premature Infant with Wernicke Encephalopathy: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924830. [PMID: 33001867 PMCID: PMC7533949 DOI: 10.12659/ajcr.924830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Patient: Male, Newborn Final Diagnosis: Short bowel syndrome Symptoms: Short bowel Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology • Geriatrics
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Affiliation(s)
- Yanzhen Zhang
- International School of Nursing, Huangshan Vocational Technical College, Huangshan, Anhui, China (mainland)
| | - Bo Zhou
- International School of Nursing, Huangshan Vocational Technical College, Huangshan, Anhui, China (mainland)
| | - Lanyan Wu
- International School of Nursing, Huangshan Vocational Technical College, Huangshan, Anhui, China (mainland)
| | - Hong Cao
- International School of Nursing, Huangshan Vocational Technical College, Huangshan, Anhui, China (mainland)
| | - Guozhong Xie
- Department of Nursing, Huangshan Changren Hospital, Huangshan, Anhui, China (mainland)
| | - Hua Fang
- Department of Nursing, Huangshan Changren Hospital, Huangshan, Anhui, China (mainland)
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