Unusual D-lactic acid acidosis from propylene glycol metabolism in overdose.
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.
Jorens
Philippe G
PG
Department of Intensive Care Medicine, University Hospital of Antwerp, Edegem, Belgium. Philippe.Jorens@uza.be
Demey
Hendrik E
HE
Schepens
Paul J C
PJ
Coucke
Vera
V
Verpooten
Gert A
GA
Couttenye
M M
MM
Van Hoof
Viviane
V
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
D012997:Solvents; D019946:Propylene Glycol