title: D-Lactic acidosis and encephalopathy after jejunoileostomy: response to overfeeding and to fasting in humans.
abstract: Two patients with recurring attacks of encephalopathy after jejunoileostomy for morbid obesity had elevated D-lactate concentrations in blood and urine. The syndrome and the biochemical abnormalities were reproduced by ingestion of a high carbohydrate diet. In the second case, fasting and intravenous supplementation with amino acids and glucose resulted in the disappearance of D-lactate from the urine and blood and amelioration of the symptoms. Stool cultures from the second patient were shown to be capable of producing D-lactate, and concentrations of D-lactate in saline and peptone yeast broth filtrates of the stool paralleled the changes in urinary excretion of the D-lactate during fasting and overfeeding. Thus, we have demonstrated a temporal relationship between the neurologic symptoms and the elevated concentrations of D-lactate in blood, urine, and stool. Whether D-lactate accounts for part or all of the encephalopathic changes remains to be determined.
mesh_terms: D000138:Acidosis / Q000209:etiology*; D000328:Adult; D001928:Brain Diseases, Metabolic / Q000209:etiology*; D005215:Fasting; D005260:Female; D005502:Food; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007583:Jejunum / Q000601:surgery*; D007773:Lactates / Q000097:blood / Q000378:metabolism* / Q000652:urine; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D011183:Postoperative Complications / Q000378:metabolism
chemical_list: D007773:Lactates