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D-lactic acidosis
Etiology:
- short-bowel syndrome
a) small bowel resection
b) jejunal-ileal bypass
Pathology:
- colon receives large quantities of carbohydrate normally aborbed in the small intestine
- colonic bacteria metabolize carbohydrate to D-lactate in the colon
- the D-lacate is absorbed from the colon into the systemic circulation
Clinical manifestations:
- patients with D-lactic acidosis generally present after ingesting a high-carbohydrate meal
- neurologic abnomalities
a) confusion
b) slurred speech
c) ataxia
Laboratory:
- serum lactate measures L-lactate, not D-lactate, thus D-lactate appears as an unmeasured anion in anion-gap metabolic acidosis
Management:
- bicarbonate as needed to correct acidosis
- low-carbohydrate diet
- antimicrobial therapy to diminish colonic bacteria
Related
lactic acidosis
General
metabolic acidosis
References
- Medical Knowledge Self Assessment Program (MKSAP) 15, 17, 18.
American College of Physicians, Philadelphia 2009, 2015, 2018.