D-lactic acidosis – a rare complication of short bowel syndrome
Authors:
Vladimír Podušel 1; Simona Morgošová 1; Pavol Majdák 1; Jurina Sadloňová 2
Authors‘ workplace:
Interné oddelenie, NsP Prievidza so sídlom v Bojniciach
1; I. interná klinika Jesseniovej lekárskej fakulty UK a Univerzitnej nemocnice v Martine
2
Published in:
Vnitř Lék 2021; 67(E-5): 28-33
Category:
Case Report
Overview
D-lactic acidosis represents a rare form of metabolic acidosis that occurs most commonly in patients with short bowel syndrome. This is a serious, sometimes life-threatening complication. The cause is the accumulation of D-lactate in the body, which is formed in excessive amounts by fermentation of unabsorbed carbohydrates by the intestinal microbiota. The nervous system is predominantly affected, which also results in clinical manifestations. The clinical picture is dominated by a wide range of non-specific neurological symptoms. The disease can sometimes manifest as somnolence to coma. From the aspect of laboratory diagnostics, the disease is characterized by severe metabolic acidosis with an increased anion gap. In this case report, we present a unique case of a 54-year-old woman with Crohn’s disease and short bowel syndrome who in a short time was repeatedly hospitalized for recurrence of severe metabolic acidosis with severe impaired consciousness. Based on the evaluation of anamnestic data, clinical picture and laboratory tests, the patient was diagnosed with D-lactic acidosis. In the discussion we discuss the individual steps that led to this diagnosis and compare our experience with data in the world literature.
Keywords:
short bowel syndrome – D-lactic acidosis – encephalopathy
Sources
1. Pironi L, Corcos O, Forbes A et al. Intestinal failure in adults: Recommendations from the ESPEN expert groups. Clin Nutr. 2018; 37: 1798–1809.
2. O’Keefe SJ, Buchman AL, Fishbein TM et al. Short Bowel Syndrome and Intestinal Failure: Consensus Definitions and Overview. Clin Gastroenterol Hepatol. 2006; 4: 6–10.
3. Oh MS, Phelps KR, Traube M, Barbosa-Saldivar JL et al. D-Lactic acidosis in a man with the short-bowel syndrome. N Engl J Med. 1979; 301: 249–252.
4. Mason PD. Metabolic acidosis due to D-lactate. Br Med J. 1986; 292: 1105–1106.
5. Wright MR, Jamali F. Methods for the analysis of enantiomers of racemic drugs application to pharmacological and pharmacokinetic studies. J Pharmacol Toxicol Methods. 1993; 29: 1–9.
6. Uribarri J, Oh MS, Carroll HJ. D-lactic acidosis. A review of clinical presentation, biochemical features, and pathophysiologic mechanisms. Medicine (Baltimore). 1998; 77: 73–82.
7. Petersen C. D-lactic acidosis. Nutr Clin Pract. 2005; 20: 634–645.
8. Spillane K, Nagendran K, Prior PF et al. Serial electroencephalograms in a patient with D-lactic acidosis. Electroencephalogr Clin Neurophysiol. 1994; 91: 403–405.
9. Kowlgi NG, Chhabra L. D-Lactic Acidosis: An Uderrecognized Complication of Short Bowel Syndrome. Gastroenterol Res Pract. 2015; 2015: 476215. doi: 10.1155/2015/476215.
10. Coronado BE, Opal SM, Yoburn DC. Antibiotic-induced D-lactic acidosis. Ann Intern Med. 1995; 122: 839–842.
11. Flourie B, Messing B, Bismuth E et al. D-lactic acidosis and encephalopathy in short- bowel syndrome occurring during antibiotic treatment. Gastroenterol Clin Biol. 1990; 14: 596–598.
12. Yilmaz B, Schibli S, Macpherson AJ et al. D-lactic Acidosis: Successful Suppression of D-lactate-Producing Lactobacillus by Probiotics. Pediatrics. 2018; 142(3): e20180337. doi: 10.1542/peds.2018–0337.
13. Day AS, Abbott GD. D-lactic acidosis in short bowel syndrome. N Z Med J. 1999; 112: 277–278.
14. Hudson M, Pocknee R, Mowat NAG. D-lactic acidosis in short bowel syndrome-an examination of possible mechanisms. Q J Med. 1990; 74: 157–163.
15. Hyšpler R et al. Spektrofotometrická metóda stanovení D-laktátu v krevní plazmě a moči. Klin. Biochem. Metab. 2015; 23: 193–197.
16. Weemaes M, Hiele M, Vermeersch P. High anion gap metabolic acidosis caused by D-lactate: mind the time of blood collection. Biochem Med (Zagreb). 2020; 30: 1–5.
17. Mayne AJ, Handy DJ, Preece MA et al. Dietary management of D-lactic acidosis in short bowel syndrome. Arch Dis Child. 1990; 65: 229–231.
18. Joyce E, Glasner P, Ranganathan S et al. Tubulointerstitial nephritis: diagnosis, treatment, and monitoring. Pediatr Nephrol. 2017; 32(4): 577–587.
19. Pham AQ, Xu LH, Moe OW. Drug-Induced Metabolic Acidosis. F1000Res. 2015; 4: F1000 Faculty Rev-1460. Published 2015 Dec 16. doi:10.12688/f1000research.7006.1
20. Takahashi K, Terashima H, Kohno K et al. A stand-alone synbiotic treatment for the prevention of D-lactic acidosis in short bowel syndrome. Int Surg. 2013; 98: 110–113.
21. Fabian E, Kramer L, Siebert F et al. D-lactic acidosis – case report and review of the literature. Z Gastroenterol. 2017; 55: 75–82.
22. Godey F, Bouasria A, Ropert M et al. Don’t forget to test for D-lactic acid in short bowel syndrome. Am J Gastroenterol. 2000; 95: 3675–3677.
23. Bongaerts G, Tolboom J, Naber T et al. D-lactic acidemia and aciduria in pediatric and adult patients with short-bowel syndrome. Clin Chem. 1995; 41: 107–110.
24. Narula RK, El Shafei A, Ramaiah D et al. D-lactic acidosis 23 years after jejuno-ileal bypass (case report). Am J Kidney Dis. 2000; 36: 1–4.
25. Dahlquist NR, Perrault J, Callaway CW et al. D-lactic acidosis and encephalopathy after jejunoileostomy: response to overfeeding and to fasting in humans. Mayo Clin Proc. 1984; 59: 141–145.
26. Coronado BE, Opal SM, Yoburn DC. Antibiotic-induced D-lactic acidosis. Ann Intern Med. 1995; 122: 839–842.
27. Flourie B, Messing B, Bismuth E et al. D-lactic acidosis and encephalopathy in short-bowel syndrome occurring during antibiotic treatment. Gastroenterol Clin Biol. 1990; 14: 596–598.
28. White L. D-lactic acidosis: more prevalent than we think? Practical Gastroenterology 2015; 39: 26–45.
29. Uchida H, Yamamoto H, Kisaki Y et al. D-lactic acidosis in short-bowel syndrome managed with antibiotics and probiotics. J Pediatr Surg. 2004; 39: 634–636.
30. Mann NS, Russman HB, Mann SK et al. Lactulose and severe lactic acidosis. Ann Intern Med 1985; 103: 637.
31. Jorens PG, Demey HE, Schepens PJ et al. Unusual D-lactic acid acidosis from propylene glycol metabolism in overdose. J Toxicol Clin Toxicol. 2004; 42: 163–169.
32. Bongaerts G, Bakkeren J, Severijnen R et al. Lactobacilli and acidosis in children with short small bowel. J Pediatr Gastroenterol Nutr. 2000; 30(3): 288–293.
33. Hove H, Mortensen PB. Colonic lactate metabolism and D-lactic acidosis. Dig Dis Sci. 1995; 40: 320–330.
34. Ponziani FR, Scaldaferri F, Petito V et al. The role of antibiotics in gut microbiota modulation: the eubiotic effects of rifaximin. Dig Dis. 2016; 34(3): 269–278.
35. Scully TB, Kraft SC, Carr WC et al. D-lactate-associated encephalopathy after massive small-bowel resection. J Clin Gastroenterol. 1989; 11: 448–451.
36. Satoh T, Narisawa K, Konno T et al. D-lactic acidosis in two patients with short bowel syndrome: bacteriological analyses of the fecal flora. Eur J Pediatr 1982; 138: 324–326.
37. Ondriová I, Fertaľová T, Magurová D. Klinické využitie probiotík v prevencii a liečbe porúch tráviaceho traktu. Klin Farmakol Farm. 2015; 29(3): 116–118.
38. Gombošová L. Mikrobiota v etiopatogenéze a liečbe symptomatickej divertikulovej choroby hrubého čreva. Gastroent Hepatol. 2019; 73: 418–422.
39. Cherbut C, Aubé AC, Blottière HM et al. Effects of short-chain fatty acids on gastrointestinal motility. Scand J Gastroenterol Suppl 1997; 222: 58–61.
40. Pape UF, Iyer KR, Jeppesen PB et al. Teduglutide for the treatment of adults with intestinal failure associated with short bowel syndrome: pooled safety data from four clinical trials. Therap Adv Gastroenterol. 2020; 13: 1–18.
41. Křížová J, Trachta P, Kotrlíková E et al. Syndrom krátkeho střeva a možnosti jeho léčby. Interná med. 2017; 17(10): 405–408.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
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