title: Effect of parenteral nutrition and enteral feeding on D-lactic acidosis in a patient with short bowel.
abstract: D-Lactic acid can accumulate in blood in some patients with intestinal failure, leading to a clinical syndrome of severe acidosis and encephalopathy. The possible impact of parenteral nutrition on its clinical course has not been established. One patient with a severe short-bowel syndrome supported by long-term parenteral nutrition who suffered repeated episodes of ataxia and disorientation associated with elevated serum levels of D-lactate was studied. Results demonstrated no impact of glucose- vs lipid-based parenteral nutrition formulations on total acid production or serum D-lactic acid levels, increased serum D-lactate levels during administration of neomycin, but prompt resolution of both acidosis and clinical symptoms with discontinuation of oral intake. This study confirms the findings of other investigators that D-lactic acidosis may be a significant, heretofore unappreciated complication in patients with severe short-bowel syndrome, and that prompt resolution may be effected with abrupt discontinuation of oral intake. Furthermore, the present study suggests neither a detrimental nor a beneficial effect of parenteral nutrition on this syndrome.
mesh_terms: D000140:Acidosis, Lactic / Q000097:blood*; D000328:Adult; D002149:Energy Intake; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007581:Jejunoileal Bypass; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D008286:Malabsorption Syndromes / Q000097:blood*; D009355:Neomycin / Q000008:administration & dosage; D019965:Neurocognitive Disorders / Q000097:blood; D009765:Obesity / Q000628:therapy; D010289:Parenteral Nutrition, Total; D012778:Short Bowel Syndrome / Q000097:blood*
chemical_list: D007773:Lactates; D019344:Lactic Acid; D009355:Neomycin