Lactic acidosis traced to thiamine deficiency related to nationwide shortage of multivitamins for total parenteral nutrition -- United States, 1997.

Since November 1996, there has been a nationwide shortage of intravenous (IV) multivitamins (MVIs) used in U.S. hospitals and home-health-care agencies for total parenteral nutrition (TPN). Patients receiving TPN without MVI supplementation are at risk for thiamine deficiency and life-threatening complications associated with severe deficiency of thiamine, a coenzyme necessary for oxidation of keto acids (Figure 1). This report describes three patients receiving TPN who had thiamine deficiency-related lactic acidosis in 1997 and presents recommendations for alternatives to parenteral MVI during the shortage.