title: D-lactic acidosis - case report and review of the literature.
abstract: D-lactic acidosis is a rare complication that occurs mainly in patients with malabsorption due to a surgically altered gastrointestinal tract anatomy, namely in short bowel syndrome or after bariatric surgery. It is characterized by rapid development of neurological symptoms and severe metabolic acidosis, often with a high serum anion gap. Malabsorbed carbohydrates can be fermented by colonic microbiota capable of producing D-lactic acid. Routine clinical assessment of serum lactate covers only L-lactic acid; when clinical suspicion for D-lactic acidosis is high, special assays for D-lactic acid are called for. A serum level of more than 3 mmol/L of D-lactate confirms the diagnosis. Management includes correction of metabolic acidosis by intravenous bicarbonate, restriction of carbohydrates or fasting, and antibiotics to eliminate intestinal bacteria that produce D-lactic acid. We report a case of D-lactic acidosis in a patient with short bowel syndrome and review the pathophysiology of D-lactic acidosis with its biochemical and clinical features. D-lactic acidosis should be considered when patients with short bowel syndrome or other malabsorption syndromes due to an altered gastrointestinal tract anatomy present with metabolic acidosis and neurological symptoms that cannot be attributed to other causes. With the growing popularity of bariatric surgery, this metabolic derangement may be seen more frequently in the future.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fabian
authors.affiliation: 1st Department of Internal Medicine with Gastroenterology, Hietzing Hospital, Vienna, Austria.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Kramer
authors.affiliation: Department of Internal Medicine, Barmherzige Brueder Hospital, St. Veit on the Glan, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Siebert
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Högenauer
authors.affiliation: Division of Angiology, Department of Internal Medicine, Medical University of Graz, Austria.
authors.forename: Reinhard Bernd
authors.initials: RB
authors.lastname: Raggam
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Austria.
authors.forename: Heimo
authors.initials: H
authors.lastname: Wenzl
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Austria.
authors.forename: Guenter J
authors.initials: GJ
authors.lastname: Krejs
mesh_terms: D000140:Acidosis, Lactic / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001639:Bicarbonates / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D004035:Diet Therapy / Q000379:methods; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D012778:Short Bowel Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001639:Bicarbonates