title: Unusual D-lactic acid acidosis from propylene glycol metabolism in overdose.
abstract: OBJECTIVE
  To report a case of D-lactic acid acidosis owing to massive oral ingestion of propylene glycol.
  
  
  METHODS
  A 72-year old man with known congestive failure was admitted to the ICU with encephalopathy. Twelve hours prior to admission he had erroneously ingested a large amount of propylene glycol (PG). The laboratory revealed high anion gap (anion gap = 27 meq/l) acidosis (arterial pH = 7.16) and an increased osmolal gap. Toxicological analysis revealed a low serum propylene glycol level. Biochemical analysis indicated that very high amounts of D-lactic acid (up to 110 mmol/l), but not of the usual type of L-lactic acid, were responsible for the metabolic acidosis. Hemodialysis was initiated and associated with a decline of both the acidosis and D-lactic acid levels. The patient regained conciousness.
  
  
  CONCLUSIONS
  Ingestion of massive doses of propylene glycol, previously not reported as a cause of D-lactic acidosis, should be added to the differential diagnosis of this rare condition.
authors.affiliation: Department of Intensive Care Medicine, University Hospital of Antwerp, Edegem, Belgium. Philippe.Jorens@uza.be
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Jorens
authors.forename: Hendrik E
authors.initials: HE
authors.lastname: Demey
authors.forename: Paul J C
authors.initials: PJ
authors.lastname: Schepens
authors.forename: Vera
authors.initials: V
authors.lastname: Coucke
authors.forename: Gert A
authors.initials: GA
authors.lastname: Verpooten
authors.forename: M M
authors.initials: MM
authors.lastname: Couttenye
authors.forename: Viviane
authors.initials: V
authors.lastname: Van Hoof
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000473:pathology; D000368:Aged; D001928:Brain Diseases, Metabolic / Q000209:etiology; D062787:Drug Overdose; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D019946:Propylene Glycol / Q000378:metabolism / Q000506:poisoning*; D012997:Solvents / Q000378:metabolism / Q000506:poisoning*; D013237:Stereoisomerism
chemical_list: D012997:Solvents; D019946:Propylene Glycol