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D-Lactic acidosis after jejunoileal bypass: identification of organic anions by nuclear magnetic resonance spectroscopy.

Abstract
A 40-year-old man with jejunoileal bypass developed a syndrome of bizarre behavior, slurred speech, ataxic gait, and inappropriate affect, associated with a metabolic acidosis characterized by an increase in the anion gap. Serum L-lactate level was normal, but high-resolution proton nuclear magnetic resonance spectrums of the patient's serum showed a high concentration of lactate. A diagnosis of D-lactic acidosis was confirmed by a specific enzymatic assay for D-lactate. The D-lactic acidosis was cleared using antibiotic therapy, suggesting that D-lactate is produced from fermentation of ingested carbohydrate by colonic bacteria. Nuclear magnetic resonance spectroscopy is a rapid screening test for identifying organic acids in patients with unexplained acidosis. Neuropsychiatric symptoms in patients with short bowel syndrome may be associated with D-lactic acidosis.
AuthorsM Traube, J L Bock, J L Boyer
JournalAnnals of internal medicine (Ann Intern Med) Vol. 98 Issue 2 Pg. 171-3 (Feb 1983) ISSN: 0003-4819 [Print] United States
PMID6824248 (Publication Type: Case Reports, Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)
Chemical References
  • Bicarbonates
  • Lactates
Topics
  • Acid-Base Equilibrium
  • Acidosis (blood, diagnosis, etiology)
  • Adult
  • Bicarbonates (blood)
  • Humans
  • Ileum (surgery)
  • Jejunum (surgery)
  • Lactates (blood)
  • Magnetic Resonance Spectroscopy
  • Male
  • Obesity (therapy)
  • Postoperative Complications

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