DOI: 10.36347/sjmcr.2023.v11i03.041

Pages: 410-413

Total parenteral nutrition is a mean of delivering nutrition intravenously. Its use is associated with vitamin deficiency. Folic acid and vitamin B12 deficiencies are a rare cause of pancytopenia, whose existence compromises the prognosis of a critically ill patient. In this report, we present the case of a 48 year old man with septic shock secondary to a gangrenous cholecystitis complicated postoperatively by an abscessed collection of the hepatic hilum, and was given total parenteral nutrition. The patient was referred to our department for specialized care, and displayed signs of severe hypovolemia and anemia, with refractory shock. Lab findings were in favor of pancytopenia, with an abdominal CT-Scan showing multiple hematomas. Patient underwent surgical intervention and was diagnosed with folic acid deficiency. He was supplemented with folic acid and vitamin B12, transfused, and switched to mixed enteral and parenteral nutrition following vasopressor drug withdrawal. Outcome was marked by the increase of platelets, hemoglobin and white blood cells, without recurrence of hemorrhage, and transfer of the patient to the surgical ward after complete recovery from the septic shock. This case highlights the importance of vitamin supplementation in patients receiving total parenteral nutrition, and the regular assessment of their complete blood count in the absence of any supplementation.