D-Lactic acidosis after jejunoileal bypass: identification of organic anions by nuclear magnetic resonance spectroscopy.
A 40-year-old man with jejunoileal bypass developed a syndrome of bizarre behavior, slurred speech, ataxic gait, and inappropriate affect, associated with a metabolic acidosis characterized by an increase in the anion gap. Serum L-lactate level was normal, but high-resolution proton nuclear magnetic resonance spectrums of the patient's serum showed a high concentration of lactate. A diagnosis of D-lactic acidosis was confirmed by a specific enzymatic assay for D-lactate. The D-lactic acidosis was cleared using antibiotic therapy, suggesting that D-lactate is produced from fermentation of ingested carbohydrate by colonic bacteria. Nuclear magnetic resonance spectroscopy is a rapid screening test for identifying organic acids in patients with unexplained acidosis. Neuropsychiatric symptoms in patients with short bowel syndrome may be associated with D-lactic acidosis.
D000136:Acid-Base Equilibrium; D000138:Acidosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D000328:Adult; D001639:Bicarbonates / Q000097:blood; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007583:Jejunum / Q000601:surgery*; D007773:Lactates / Q000097:blood*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D009765:Obesity / Q000628:therapy*; D011183:Postoperative Complications
D001639:Bicarbonates; D007773:Lactates