D-Lactic Acidosis in Short Bowel Syndrome

Ayham Khrais; Hasan Ali; Sung Choi; Ahmed Ahmed; Sushil Ahlawat

doi:10.7759/cureus.25471

D-Lactic Acidosis in Short Bowel Syndrome

Cureus. 2022 May 30;14(5):e25471. doi: 10.7759/cureus.25471. eCollection 2022 May.

Authors

Ayham Khrais¹, Hasan Ali¹, Sung Choi², Ahmed Ahmed³, Sushil Ahlawat⁴

Affiliations

¹ Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA.
² Pulmonary and Critical Care, Rutgers University New Jersey Medical School, Newark, USA.
³ Gastroenterology and Hepatology, Rutgers University New Jersey Medical School, Newark, USA.
⁴ Gastroenterology and Hepatology, Rutgers University, Newark, USA.

Abstract

D-lactic acidosis (D-LA) is closely associated with short bowel syndrome (SBS). Decreased intestinal absorption results in the delivery of carbohydrates to the colon, where the fermentation by colonic flora leads to D-LA. Systemic absorption of D-lactic acid results in anion-gap metabolic acidosis (AGMA), LA, and neurologic symptoms. In this report, we describe the case of a 43-year-old man with Crohn's disease (CD) and bowel resection who presented with abdominal pain and slurred speech. He was found to have AGMA and persistent LA despite receiving intravenous fluids, which improved after carbohydrate restriction. A high index of suspicion for D-LA should be maintained when encountering patients who have undergone bowel resection and with unexplained AGMA.

Keywords: anion gap mmetabolic acidosis; crohn’s disease (cd); d-lactic acidosis; lactic acidosis; short bowel syndrome.

Publication types

Case Reports