D-Lactic Acidosis Due to Abnormal Gut Flora

Abstract

METABOLIC acidosis caused by D-lactic acid, the optical isomer of L-lactic acid, was recently described by Oh et al. in a patient with a short-bowel syndrome.1 We encountered a similar condition in two patients with prior gut surgery. One patient had undergone an extensive small-bowel resection after mesenteric infarction, and the other had had a jejunoileal bypass for obesity. These patients presented with repeated episodes of stupor or coma, metabolic acidosis with an increased anion gap, normal plasma levels of L-lactate, and elevated plasma levels of D-lactate. Treatment with oral vancomycin resulted in normalization of the neurologic and metabolic status. . . .