Severe Lactic Acidosis in a Parenteral Nutrition-Dependent Teenager with Ulcerative Colitis

Excerpt

A 16-year-old male with previously diagnosed ulcerative colitis (UC) was initially admitted to an outside hospital because of bloody diarrhea. Total parenteral nutrition (TPN) was started after admission, but after failure of medical management of his UC with steroids and infliximab, he underwent a total colectomy with an end ileostomy. His postoperative course was complicated by pancreatitis and ileus, requiring prolonged nothing-by-mouth status with TPN. On hospital day 32, he developed ataxia, tremors, and auditory hallucinations. Over the next 2 days, his serum bicarbonate concentration decreased to a low level of 11 mmol/L, and his serum lactate concentration rose to 16 mmol/L. Although his physicians were clinically suspicious of bowel ischemia or abdominal infection, an abdominal computed tomography (CT) scan was reported to show no evidence of either. A course of empiric broad-spectrum antibiotics was started; 3 days later, the patient developed hypotension, requiring vasopressor therapy and prophylactic intubation for impending respiratory failure. The patient then was transferred to our pediatric intensive care unit (PICU) for escalation of care. …