Pyruvate Dehydrogenase & Pyruvate Fates | USMLE Step 1
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A 54-year-old woman has received parenteral nutrition for 24 days after surgery complicated by a prolonged ileus. She becomes inattentive and develops horizontal nystagmus. Her blood pressure is 118/72 mm Hg and oxygen saturation is 98% on room air. Lactate rises from 2.1 to 7.4 mmol/L after the carbohydrate infusion is increased. A pharmacy review finds that the multivitamin additive has been omitted. A parenteral vitamin is administered promptly, and lactate falls over the next several hours.