D-lactic acidosis in short-bowel syndrome managed with antibiotics and probiotics

Uchida, Hiroo; Yamamoto, Hideki; Kisaki, Yoshiyuki; Fujino, Junko; Ishimaru, Yuki; Ikeda, Hitoshi

doi:10.1016/j.jpedsurg.2003.12.026

Cited by 78 publications

(56 citation statements)

References 13 publications

(10 reference statements)

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“…In patients with SBS, a syndrome that includes altered mental status, slurred speech, ataxia, metabolic acidosis, and elevation of plasma d-lactate concentration (d-lactic acidosis) occasionally occurs [27,28]. In this setting, malabsorbed carbohydrate is fermented by colonic bacteria (and/or small bowel bacteria in SBBO), which produces excessive amounts of d-lactate [27][28][29].…”

Section: Signs and Symptomsmentioning

confidence: 99%

See 1 more Smart Citation

Small bowel bacterial overgrowth in adults: A potential contributor to intestinal failure

Ziegler

Cole²

2007

Curr Gastroenterol Rep

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Small bowel bacterial overgrowth (SBBO), in which colon-derived bacteria colonize the upper small bowel, is found in a wide variety of adult diseases associated with intestinal failure and dysfunction, including short bowel syndrome and other conditions following massive bowel resection, dysmotility disorders, and inflammatory bowel disease. SBBO also appears to be relatively common in the elderly, in whom it often goes unrecognized. SBBO is an important cause of malabsorption and thus may contribute to diarrhea and malnutrition. Elevated upper small intestinal aspirate colony counts remain the gold standard diagnostic test; a variety of noninvasive tests that detect elevated levels of breath hydrogen produced by bacterial fermentation of oral carbohydrate loads are also performed for diagnosis. Physicians commonly prescribe a variety of oral antibiotic regimens for documented or presumed SBBO. Additional research is needed to define the epidemiology, optimal diagnostic test(s), and therapeutic regimens for this condition.

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Section: Signs and Symptomsmentioning

confidence: 99%

“…In this setting, malabsorbed carbohydrate is fermented by colonic bacteria (and/or small bowel bacteria in SBBO), which produces excessive amounts of d-lactate [27][28][29]. Patients with SBS also have gut barrier dysfunction and abnormal gut permeability to sugar markers [1,30,31].…”

Section: Signs and Symptomsmentioning

confidence: 99%

Small bowel bacterial overgrowth in adults: A potential contributor to intestinal failure

Ziegler

Cole²

2007

Curr Gastroenterol Rep

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“…A level greater than 3 mmol/L is diagnostic for this condition. 1 Measurement of D-lactate, however, is not available routinely in most hospital laboratories. Urinary D-lactate assays may be faster, easier to use and more sensitive than serologic assays.…”

Section: Discussionmentioning

confidence: 99%

“…9 This finding suggests the presence of other mediators associated with D-lactate. 1,5,9 However, infusing D-lactate into peripheral venous blood may not reproduce the clinical presentation associated with D-lactic acidosis because D-lactate absorbed from the colon passes through the portal circulation and into the liver before being released into the systemic circulation.…”

Section: Neurologic Findingsmentioning

confidence: 99%

D-lactic acidosis and ataxia in a man with Crohn disease

James¹,

Black²,

Kuper³

et al. 2010

Canadian Medical Association Journal

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A 49-year-old man presented to the emergency department with an eight-hour history of unsteady gait, impaired concentration, difficulty speaking and blurry vision, which had developed over the previous seven hours. During the preceding two days, he had been excessively thirsty and drank large amounts of water, cola and a "sports drink." He had eaten a large portion of rice with dinner the evening before presentation. On the day he presented, he had awoken in the morning feeling dizzy. As he was leaving for work, he had experienced difficulty using his keys and turning doorknobs.The patient's medical history included Crohn disease and two major small-bowel resections at 33 and 35 years of age that had left about one metre of small intestine. He had undergone an esophageal bougienage three weeks earlier for a stricture related to Crohn disease. After the bougienage, the patient had regained his ability to consume solids and dramatically increased his caloric intake to regain weight. His diet consisted mainly of fast food, candy bars and soft drinks.The patient reported that he did not smoke, consume substantial amounts of alcohol or have any drug allergies. On a daily basis, he took prednisone 20 mg, loperamide 2-4 mg, vitamin B 12 and multivitamins. Except for the addition of prednisone for the Crohn-related stricture, his regimen of medications had not changed during the past year. He had experienced no changes in his usual Crohn symptoms.On clinical examination, the patient was alert, oriented and not in distress. His vital signs were normal and he had no significant postural changes. Other than mild vertical and horizontal nystagmus, the results of cranial nerve testing were normal. The patient had truncal ataxia and notable dysmetria on finger-nose testing. He had an unsteady, wide-based gait and could not tolerate walking more than five steps. Rapid alternating movements and heel-shin tests were normal. His strength and reflexes, and the results of sensory testing, were normal. The rest of the clinical examination was unremarkable except for midline abdominal surgical scars.Initial laboratory investigations are presented in Table 1 and include a serum carbon dioxide level of 10 mmol/L with an anion gap of 22 mEq/L. Complete blood count, creatinine, coagulation studies, liver enzymes and urinalysis were within normal limits. Arterial blood gas analysis showed a pH of 7.21, partial pressure of carbon dioxide (pCO 2 ) of 23, partial pressure of oxygen (pO 2) of 119 and HCO 3 -of 9. Serum lacCases

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“…D-lactic acidosis is a rare complication and is associated with bacterial overgrowth of lactobacilli strains producing D-lactic acid rather than other short-chain fatty acids and hydrogen (9). It is best treated with antibiotics and a reduced intake of mono-and disaccharides.…”

mentioning

confidence: 99%

Clinical problem-solving: Short bowel syndrome in an infant

Groleau

Beaunoyer

et al. 2013

Paediatrics and Child Health

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A 2870 g male infant with a prenatal diagnosis of intestinal obstruction was delivered uneventfully after 36 weeks of gestation, during which polyhydramnios was noted. Ultrasound of the abdomen confirmed the upper small intestinal obstruction.In a recent survey of 18 congenital malformation registries in Europe, the rate of prenatal ultrasonographic detection of intestinal obstruction was 52% for duodenal obstruction, 40% for the small bowel and 29% for the colon (1).

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D-lactic acidosis in short-bowel syndrome managed with antibiotics and probiotics

Cited by 78 publications

References 13 publications

Small bowel bacterial overgrowth in adults: A potential contributor to intestinal failure

Small bowel bacterial overgrowth in adults: A potential contributor to intestinal failure

D-lactic acidosis and ataxia in a man with Crohn disease

Clinical problem-solving: Short bowel syndrome in an infant

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