D-lactic acidosis

Etiology

• short-bowel syndrome
  • small bowel resection
  • 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
  • confusion
  • slurred speech
  • 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

More general terms

• metabolic acidosis

Additional terms

• lactic acidosis