D-Lactic Acidosis in a Man with the Short-Bowel Syndrome

TLDR

A patient with short‑bowel syndrome presented with neurologic symptoms and severe metabolic acidosis. Chemical analysis identified D‑lactic acid as the culprit, and the patient underwent emergency jejunoileostomy after mesenteric‑vein thrombosis. The anion gap was elevated, and the abnormal anion was determined to be D‑lactic acid, a known cause of metabolic acidosis in veterinary medicine. No other information.

Abstract

WE have recently studied a patient who had short-bowel syndrome that presented with peculiar neurologic manifestations and severe metabolic acidosis. The anion gap was increased, but the identity of the abnormal anion was not readily apparent. By several chemical technics the agent responsible for metabolic acidosis was found to be D-lactic acid — a cause of metabolic acidosis familiar to veterinarians but not to physicians.Case HistoryThe patient, a 30-year-old man, was in good health until July, 1975, when a superior mesenteric-vein thrombosis of unknown cause resulted in gangrene of most of the small intestine. After emergency jejunoileostomy with . . .