D-lactic Acidosis in Children with Short Bowel Syndrome

Chiatto, F.; Forsythe, Lynette; Coletta, Riccardo; Solari, Valeria; Alseiri, Bashar; Morabito, Antonino

doi:10.1097/01.tp.0000521485.05347.d3

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“…There are several theories including a direct effect of D‐lactate, associated acidosis, interference of pyruvate metabolism, lack of D‐2‐HDH in the brain, production of toxic metabolites, and nutritional deficiencies 6,7,20,27,28 . Management consists of supportive care involving the correction of acidosis with rehydration and bicarbonate, oral antibiotics to reduce bacterial load of the GI tract, restriction of enteral carbohydrates, thiamine supplementation, and in severe cases, hemodialysis 4,5,18,29 . Over half of our cohort were on antibiotics for SBBO at the time of DLA testing.…”

Section: Discussionmentioning

confidence: 99%

“…6,7,20,27,28 Management consists of supportive care involving the correction of acidosis with rehydration and bicarbonate, oral antibiotics to reduce bacterial load of the GI tract, restriction of enteral carbohydrates, thiamine supplementation, and in severe cases, hemodialysis. 4,5,18,29 Over half of our cohort were on antibiotics for SBBO at the time of DLA testing. Metronidazole was the most common antibiotic in those with elevated D-lactate, followed by ciprofloxacin.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with D‐lactic acidosis in pediatric intestinal failure: A case‐control study

Nes,

Knell,

Keefe

et al. 2023

J. pediatr. gastroenterol. nutr.

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BackgroundD‐lactic acidosis (DLA) is a serious complication of short bowel syndrome (SBS) in children with intestinal failure (IF). Malabsorbed carbohydrates are metabolized by bacteria in the intestine to D‐lactate which can lead to metabolic acidosis and neurologic symptoms.MethodsA retrospective chart review was performed in children ≤18 years old with SBS who had one of the following criteria: unexplained metabolic acidosis, neurologic signs or symptoms, history of antibiotic therapy for small bowel bacterial overgrowth, or high clinical suspicion of DLA. Cases had serum D‐lactate concentration >0.25 mmol/L; controls with concentrations ≤0.25 mmol/L.ResultsOf forty‐six children, median age was 3.16 (interquartile range (IQR): 1.98, 5.82) years, and median residual bowel length was 40 (IQR: 25, 59) cm. There were 23 cases and 23 controls. Univariate analysis showed that cases had significantly lower median bicarbonate (19 vs. 24 mEq/L, p = 0.001), higher anion gap (17 vs. 14 mEq/L, p < 0.001) and were less likely to be receiving parenteral nutrition, compared with children without DLA. Multivariable analysis identified midgut volvulus, history of intestinal lengthening procedure, and anion gap as significant independent risk factors. Midgut volvulus was the strongest independent factor associated with DLA (adjusted odds ratio = 17.1, 95% CI: 2.21, 133, p = 0.007).ConclusionDLA is an important complication of pediatric IF due to SBS. Patients with IF, particularly those with history of midgut volvulus, having undergone intestinal lengthening, or with anion gap acidosis, should be closely monitored for DLA.

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Section: Discussionmentioning

confidence: 99%