A patient with severe lactic acidosis and rapidly evolving multiple organ failure: a case of shoshin beri-beri.

摘要

Sir: A 50-year-old manle presented to the emergency department complaining of progressive dyspnea and muscular weakness both lasting for several days. At admission his temperature was 37.5degC, blood pressure 90/50 mmHg, heart rate 135/min, and respiratory rate 25-30/min. The laboratory investigation was inconclusive except for pronounced lactic acidosis with pH 7.08, pCO2 24 mmHg, lactate 186.5 mg/dl (normal 5.7-22.0), base excess -20 mmol/1 and anion gap of 36 mmol/1. The hemostatic parameters, and liver and kidney function tests were normal. Electrocardiogra-phyThe ECG showed no features suggestive of myocardial ischemia. A diagnostic computed tomography did not revealed no significant causative pathology except for small bilateral pleural effusions. Since the patient hemodynamic status was rapidly deteriorating, he was transferred to the intensive care unit. Upon arrival, the patient became even more unstable. A pulmonary artery catheter was inserted which showed cardiac index of 4.8 1 /min~(-1) /m~(-2), pulmo-nary arterial occlusion pressure 22 mmHg, and systemic vascular resistance index 950 dynes, sec~(-1). m~(-2)/ cm~(-5)- mixed venous oxygen saturation of 78%, and central venous pressure of 14 mmHg. The patient was intubated and mechanically ventilated.