D-lactic acidosis simulating a hypothalamic syndrome after bowel bypass.
A 36-year-old man had one year of periodic symptoms suggestive of episodic hypothalamic dysfunction: hypersomnia, thirst, ravenous hunger and gorging behavior, pallor, and irritability. However, neuroendocrine testing proved normal. A mild transient acidosis at the onset of his attacks and a history of bowel bypass five years earlier prompted metabolic screening. Markedly increased urinary D-lactic and phenolic acids were present, as were intermittent elevations of plasma D-lactic acid during two symptomatic episodes. Prompt and sustained clinical remission coincided with disappearance of abnormal organic acid excretion during oral antibiotic therapy. D-Lactic acidosis must be considered in the differential diagnosis of otherwise unexplained neurological syndromes, particularly in patients with altered bowel anatomy.
D000138:Acidosis / Q000175:diagnosis* / Q000209:etiology; D000328:Adult; D003937:Diagnosis, Differential; D006801:Humans; D007027:Hypothalamic Diseases / Q000175:diagnosis*; D007082:Ileum / Q000601:surgery; D007583:Jejunum / Q000601:surgery; D007773:Lactates; D008297:Male; D013514:Surgical Procedures, Operative / Q000009:adverse effects
D007773:Lactates