Review Article

D-Lactic Acidosis: An Underrecognized Complication of Short Bowel Syndrome

Table 1

Case reports of D-lactic acidosis with short bowel syndrome.

Author/yearPatientsAge/sexCause of D-laComments/clinical

Kholostova et al./2014 [44]24<2 yrs./variableSBS—ileojejunal rectal anastomosis for treatment of Hirschsprung’s diseaseFecal D-lactate increased in 35% pts.
Singh et al./2013 [45]137/MAntibiotic induced alteration of colonic flora causing recurrent D-laComplicated with new acute transient systolic CHF
Dahlquist et al./1984 [37]124/FSBS—ischemic small bowel resectionPrimarily CNS symptoms-lethargy, echolalia, ataxia
Burski et al./2013 [46]141/FSBS—bariatric surgeryConfusion (feeling drunk), slurred speech, ataxia.
Gigante et al./2012 [47]151/FSBS—partial small bowel resection, jejunoileal bypass due to Salmonella enteritidis infectionConfusion, blurred vision, slurred speech, nausea, weakness
Guerrero et al./2010 [48]135/FSBS—ileal resection due to ischemic bowelDizziness, gait instability, loss of strength
Munakata et al./2010 [42]15/FSBS—jejunoileal atresia; ileus; peritonitis
probiotic use—Bifidobacterium
Intermittent ataxia, inability to grasp objects, explosive speech
Grunert et al./2010 [49]17/MCongenital disaccharidase deficiencyFound comatose after parenteral nutrition was held, and pt. had oral meals, slurred speech
Dahhak et al./2008 [50]16/MSBS—bowel surgery indication not reportedDysarthria and disorientation
Soler Palacín et al./2006 [51]111/MSBS—multiple bowel resections in the postnatal periodConfusion, encephalopathy, slurred speech
Puwanant et al./2005 [52]114/MSBS—midgut volvulus surgery five years priorEpisodic confusion, hyperpnea
Uchida et al./2004 [53]122/MSBS—volvulus surgery at age threeSlurred speech, somnolence, gait disturbance
Zhang et al./2003 [16]112/MSBS—20 cm resection of small bowel due to volvulus11 episodes of weakness, ataxia, nausea, slurred speech, lethargy
Kamar et al./2003 [54]180/MSBS—subtotal colectomy with ileal J-pouchConfusion, disorientation, tachypnea
Azhar and Beach/2002 [55]153/FSBS—colectomy and colostomy 20 years prior to Ulcerative colitisNausea, vomiting, fatigue, diarrhea from colostomy
Angelet et al./2002 [56]1UnknownSBSNeurological symptoms
Lalive et al./2001 [57]154/—SBS—extensive small bowel surgery few months priorSeveral acute confusional episodes, ataxia, nystagmus, dysarthria
Sela et al./1999 [58]22.25/F
1.5/M
SBS—congenital intestinal obstructionEncephalopathy, ataxia
Day and Abbott/1999 [5]1UnknownSBSUnknown
Vella and Farrugia/1998 [33]150/FSBSRecurrent weakness, ataxia, slurred speech, confusion, nausea
Coronado et al./1995 [9]150/MSBS—Jejunoileal bypass 2 years prior, with recent doxycycline useAtaxia, slurred speech, weakness
Koletzko et al./1994 [59]19/MSBS—small intestinal duplication 2 years priorRecurrent episodes—failure to thrive, unsteady gait, slurred speech, somnolence
Gurevitch et al./1993 [60]11.6 yrs.SBS—midgut volvulusEncephalopathy syndrome
Forsyth et al./1991 [61]1UnknownSBS—jejunal atresiaRecurrent encephalopathy, treated with neomycin
Flourie et al./1990 [35]124/M SBS—recent treatment with BactrimNeurological symptoms
Scully et al./1989 [31]116/MSBS—small bowel ischemia from stab woundsHeadache, confusion, stupor, dysarthria
Rosenthal and Pesce/1985 [62]12.5/MSBS—midgut volvulusAtaxia, lethargy
Haan et al./1985 [63]18/MSBSDepression, slurred speech, confusion, aggressive behavior intermittently
Traube et al./1983 [64]140/MSBS—jejunoileal bypassBizarre behavior, slurred speech, ataxic gait
Satoh et al./1982 [65]2UnknownSBSUnknown
Schoorel et al./1980 [66]13/MSBSConfusion, dyspnea, drowsiness
Oh et al./1979 [2]130/MSBS—ischemic bowelSlurred speech, confusion