Metabolic acidosis in short bowel syndrome: think D-lactic acid acidosis

Stanciu, Sorin; Silva, Aminda De

doi:10.1136/bcr-2018-224221

Cited by 6 publications

(6 citation statements)

References 7 publications

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“…Increased concentrations of L- and especially D-lactate in the lumen of the GIT and subsequent absorption into systemic circulation play an important role in the local and systemic abnormalities observed in calves with diarrhea ( 13 , 39 – 41 ). In horses with carbohydrate overload ( 30 , 31 ), cattle with ruminal acidosis ( 42 , 43 ) and humans with SBD ( 42 , 43 ), luminal concentrations of D- and L-lactate are increased. These alteration are associated with decrease lactic acid fermentation from both proliferation of lactate-producing bacteria and inhibition of lactate fermenting bacteria because of the availability of carbohydrates ( 30 , 34 ).…”

Section: Discussionmentioning

confidence: 99%

Calf Diarrhea Is Associated With a Shift From Obligated to Facultative Anaerobes and Expansion of Lactate-Producing Bacteria

Gómez

Goetz

et al. 2022

Front. Vet. Sci.

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Diarrhea is the leading cause of morbidity, mortality and antimicrobial drug use in calves during the first month of age. Alteration in the bacterial communities of the gastrointestinal tract occurs during diarrhea. Diarrheic calves often develop anion gap (AG) acidosis associated with increased concentrations of unmeasured anions including D- and L-lactate. However, studies investigating the association between gut microbiota alterations and the development of acid-base disorders in diarrheic calves are lacking. We investigated the fecal bacterial alterations of calves with diarrhea and its association with changes in blood pH, and AG. Blood and fecal samples from healthy and diarrheic veal calves were taken 7 days after arrival to the farm. The fecal microbiota of healthy and diarrheic calves was assessed by sequencing of 16S ribosomal RNA gene amplicons. Blood gas analysis was completed using an i-Stat analyzer. In healthy calves, higher richness, evenness, and diversity were observed compared to diarrheic calves. Phocaeicola, Bacteroides, Prevotella, Faecalibacterium, Butyricicoccus, Ruminococcaceae and Lachnospiraceae were enriched in healthy compared with diarrheic calves. Enterococcus, Ligilactobacillus, Lactobacilus, Gallibacterium Streptococcus, and Escherichia/Shigella were enriched in diarrheic calves. In diarrheic calves, an increased abundance of lactate-producing bacteria including Lactobacillus, Streptococcus, Veillonella, Ligilactobacillus and Olsenella was detected. Diarrheic calves had a lower pH and bicarbonate concentration and a higher AG concentration than healthy calves. Together, these results indicate that calf diarrhea is associated with a shift from obligated to facultative anaerobes and expansion of lactate-producing bacteria which are related to acidemia, low bicarbonate and increase AG. Our results highlight the importance of the gastrointestinal microbiota on the clinicopathological changes observed in diarrheic calves.

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Section: Discussionmentioning

confidence: 99%

Calf Diarrhea Is Associated With a Shift From Obligated to Facultative Anaerobes and Expansion of Lactate-Producing Bacteria

Gómez

Goetz

et al. 2022

Front. Vet. Sci.

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“…Short bowel syndrome often causes various metabolic acid-base disorders, and some cases of alkalosis have been reported [9]. Conversely, severe acidosis has been reported in a hemodialysis patient [4], likely caused by abnormal production of d-lactate [4][5][6]. However, in the present case, we almost totally resected the colon in which d-lactate producing bacteria grows; thus, this mechanism no longer had an effect on metabolic acidosis.…”

Section: Discussionmentioning

confidence: 71%

“…It has been reported that metabolic acidosis occurs in hemodialysis patients with short bowel syndrome [4,5]. In addition to the fact that hemodialysis patients usually tend to be acidotic due to the accumulation of non-volatile acids, it seems that there was an overproduction of d-lactate in these cases [4][5][6]. However, to the best of our knowledge, there have been no reports of an alkalotic hemodialysis patient with short bowel syndrome.…”

Section: Introductionmentioning

confidence: 99%

Metabolic alkalosis due to short bowel syndrome in a hemodialysis patient

et al. 2020

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A 53-year-old man on hemodialysis suffered from short bowel syndrome after subtotal colectomy and partial resection of the small intestine. Laboratory tests showed multiple electrolyte disorders and enlarged sodium and chloride ion (Cl −) gaps despite treatment with large volume of sodium chloride replacement via central venous infusion. Blood gas analysis showed slightly high bicarbonate ion levels and metabolic alkalosis was suspected, which is uncommon in end stage kidney disease. The measurement of electrolytes in feces from ileostomy showed relatively high Cl − excretion. The loss of Cl − to feces may have caused the metabolic alkalosis; thus, additional Cl − replacement may have been necessary.

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“…In contrast to L-LA, serum AG in D-LA is lower than the decrease in serum bicarbonate, and can thus be normal. Therefore, D-LA may also result in hyperchloremic metabolic acidosis [1,5,8]. This is due to the inefficient reabsorption of D-lactate by the kidney, caused by the lack of D-lactate-specific receptors in the lumen of the proximal tubule.…”

Section: Discussionmentioning

confidence: 99%

D-Lactic Acidosis in Short Bowel Syndrome

Khrais¹,

Hasan²,

Choi³

et al. 2022

Cureus

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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.

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Metabolic acidosis in short bowel syndrome: think D-lactic acid acidosis

Cited by 6 publications

References 7 publications

Calf Diarrhea Is Associated With a Shift From Obligated to Facultative Anaerobes and Expansion of Lactate-Producing Bacteria

Calf Diarrhea Is Associated With a Shift From Obligated to Facultative Anaerobes and Expansion of Lactate-Producing Bacteria

Metabolic alkalosis due to short bowel syndrome in a hemodialysis patient

D-Lactic Acidosis in Short Bowel Syndrome

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