D-Lactic Acidosis

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October 11, 2018 by dailybolusoflr

By: Nour Al Jalbout MD


What is D-lactic acidosis?

It is a form of lactic acidosis produced by colonic bacteria. In patients with an absent or shortened small intestine, simple carbohydrates are not absorbed normally and arrive to the colon where they are fermented by bacteria – thus producing organic acids and d-lactate.


When to suspect it?

Suspect it in patients with short bowel syndrome, bariatric surgery, congenital abnormalities, or inflammatory bowel disease. Usually there will be a metabolic acidosis – either anion gap or hyperchloremic metabolic acidosis may be present though anion gap metabolic acidosis is more common.


Do we measure it in our standard lab assay?

Special assays are needed to detect D-lactate. Our standard assays measure L-Lactate.


References

Kraut JA, Madias NE. Lactic acidosis. N Engl J Med. 2014 Dec 11;371(24):2309-19

Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc. 2013 Oct;88(10):1127-40

Kowlgi NG, Chhabra L. D-lactic acidosis: an underrecognized complication of short bowel syndrome. Gastroenterol Res Pract. 2015;2015:476215

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