An extreme and life-threatening case of recurrent D-lactate encephalopathy

Abstract

D-lactic acidosis has been reported in patients after a variety of gastrointestinal surgeries, particularly jejunoileal bypass. An insufficient length of small intestine to metabolize ingested carbohydrates leads to an abnormal carbohydrate load in the colon. These carbohydrates are metabolized by colonic anaerobes (especially Lactobacillus species) into the dextrorotary isomer of lactate. Unlike its levorotary counterpart, D-lactate has neurotoxic effects and patients suffering from a significant D-lactate burden may suffer encephalopathic symptoms. These symptoms are usually mild and self-limiting in patients with normal renal function. We present here a case of D-lactic acidosis in a patient with end-stage renal disease who developed recurrent and life-threatening respiratory failure due to severe D-lactic acid encephalopathy. To our knowledge, no previously reported case has been sufficiently severe to necessitate endotracheal intubation and mechanical ventilation. An array of treatments including hemodialysis effected a prompt reversal of sensorium to baseline. We describe the potential treatments for D-lactic acidosis, which can be viewed as a paradigm of substrate, catalyst and pathologic product and review reports of their relative efficacy.

Examining clinical similarities between myalgic encephalomyelitis/chronic fatigue syndrome and d-lactic acidosis: a systematic review

“…The fluctuating neurological symptoms that present in both d -la and ME/CFS may vary in severity and the corresponding treatment response [ 66 ]. Htyte et al [ 40 ] described these transient symptoms as “usually mild and self-limiting in patients with normal renal function” (p. 1435), highlighting the individual variation in presentation and reporting of symptoms with less severe symptoms unlikely to prompt acute emergency care.…”

“…A subclinical elevation of d -lactate has been reported in SBS patients and diverse populations [ 94 ]. Higher d -lactate levels were recorded in 2.8% of randomly selected hospital patients [ 40 ]. Minimal details were provided about this sample other than noting that 40% of these patients did not have a history of gastrointestinal surgery [ 40 ].…”

“…Higher d -lactate levels were recorded in 2.8% of randomly selected hospital patients [ 40 ]. Minimal details were provided about this sample other than noting that 40% of these patients did not have a history of gastrointestinal surgery [ 40 ]. Higher levels of d -lactate have also been recorded in response to trauma or infection [ 95 ]; and in patients with diabetes compared with healthy controls [ 96 ].…”

The status of probiotics supplementation during pregnancy

“…will produce more lactic acid which may result in lactic acidosis. 35 The lactic acidosis had been reported in patients with short bowel syndrome, with or without the use of probiotics. [35][36][37] Neurologic sequelae can follow this condition, such as ataxia, slurred speech, memory loss, even loss of consciousness.…”

“…35 The lactic acidosis had been reported in patients with short bowel syndrome, with or without the use of probiotics. [35][36][37] Neurologic sequelae can follow this condition, such as ataxia, slurred speech, memory loss, even loss of consciousness. One of the cases of lactic acidosis 36 triggered by probiotics use a combination of Lactobacillus acidophilus and Bifidobacterium infantis to reduce diarrhea on two year-old post gut resection infant.…”