D-lactate and metabolic bone disease in patients receiving long-term parenteral nutrition.
D-lactate accumulates in some patients with malabsorption who continue oral intake of carbohydrate leading to a clinical syndrome of acidosis and encephalopathy. To assess the possibility that D-lactate contributes to acidosis and/or metabolic bone disease in patients with malabsorption receiving long-term parenteral nutrition yet maintaining oral intake, D-lactate levels in serum and urine were measured in 14 long-term parenteral nutrition subjects (average duration of support 74 months) and 27 control subjects. Significant elevations in both serum and urine D-lactate were found in only two parenteral nutrition subjects. Both subjects with elevated D-lactate levels had bone pain, x-ray evidence of fractures, and biopsy evidence of osteomalacia. These studies suggest that D-lactate accumulation may be a heretofore unappreciated metabolic abnormality associated with metabolic bone disease and acidosis in patients with malabsorption who are supported by long-term parenteral nutrition.
Karton
M A
MA
Department of Medicine, University of Washington, Seattle 98195.
Rettmer
R
R
Lipkin
E W
EW
Ott
S M
SM
Chait
A
A
D000140:Acidosis, Lactic / Q000209:etiology; D000328:Adult; D000368:Aged; D001706:Biopsy; D001851:Bone Diseases, Metabolic / Q000209:etiology* / Q000473:pathology; D001842:Bone and Bones / Q000473:pathology; D005260:Female; D006801:Humans; D007773:Lactates / Q000378:metabolism*; D008286:Malabsorption Syndromes / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010018:Osteomalacia / Q000150:complications / Q000209:etiology / Q000473:pathology; D010288:Parenteral Nutrition / Q000009:adverse effects*
D007773:Lactates