티아민 결핍에 의해 유발된 젖산산증 1예
A case of lactic acidosis caused by thiamine deficiency
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초록
저자들은 비타민의 공급 없이 총정맥영양법을 시행 중에 발생한 젖산산증에서 티아민 공급 후 수시간 이내로 산증이 교정된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이며, 티아민을 공급하지 않는 총정맥영양법을 장기적으로 시행 중 발생한 젖산산증에는 티아민 결핍에 의한 젖산산증의 가능성을 반드시 염두에 두어야 할 것으로 사료된다.
Abstract
Lactic acidosis commonly occurs in association with shock. We encountered lactic acidosis in a patient with normal blood pressure. The patient was a 17 year-old man with acute lymphocytic leukemia. He was admitted for bone marrow transplantation. During hospitalization, he relied on total parenteral nutrition due to his poor oral intake. On the 37th day after admission, he developed lactic acidosis without an episode of hypotension or any causative medication. Because vitamins were not included in the parenteral nutrition, we prescribed thiamine replacement, and this corrected the acidosis within a few hours. Thiamine (in its active derivative) is a coenzyme for pyruvate dehydrogenase; thus, its deficiency causes accumulation of pyruvate and lactate. This case suggests that thiamine deficiency should be included in a differential diagnosis of lactic acidosis in patients who are on total parenteral nutrition without vitamin supplementation.(Korean J Med 73:443-447, 2007)
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