Successful correction of D‐lactic acid neurotoxicity (drunken lamb syndrome) by bolus administration of oral sodium bicarbonate

Abstract

Drunken lamb syndrome (DLS) has recently been described as lamb D-lactic acidosis syndrome (LDLAS). In 2012, 18 lambs aged between 7 days and 28 days with LDLAS were identified. Biochemically, each lamb had a metabolic acidosis characterised by D-lactic acidosis and exhibited clinical signs including: not hyperthermic, no evidence of dehydration, demonstrating an ataxic gait tending to recumbency (DLS) and possibly somnolence. These lambs received 50 mmol of sodium bicarbonate as an 8.4 per cent solution given orally, together with parenteral long-acting amoxicillin. All 18 cases made a full clinical recovery. This study demonstrates a novel effective treatment for a disease that is usually fatal, and also demonstrates a strong correlation between venous plasma bicarbonate concentrations and venous plasma D-lactate concentrations (R(2)=0.49).

D-Lactic Acid as a Metabolite: Toxicology, Diagnosis, and Detection

“…D-Lactate has a direct neurotoxic effect that is independent to the drop of blood pH and not common to L-lactate which was extensively scrutinized on Holstein calves as an experimental model [ 65 ]. In a case of D-lactate-poisoned lambs, acidosis, ataxic gait and preferred recumbency, and possible somnolence were identified and the symptoms can be suppressed by sodium bicarbonate [ 66 ]. Encephalopathy is also a common syndrome of D-lactate poisoning [ 67 , 68 ].…”

Clinical use of plasma lactate concentration. Part 1: Physiology, pathophysiology, and measurement

“…In people, D‐hyperlactatemia induced encephalopathy is recognized with short bowel syndrome, and D‐lactate is suspected to be an important contributor to the high anion gap seen in diabetic ketoacidosis . Both D‐and L‐lactate are readily produced in ruminant species during the fermentation of carbohydrates by ruminal flora, and encephalopathy from D‐lactic acidosis is well‐documented due to grain overload, ruminal acidosis, calf diarrhea, drunken lamb syndrome, and floppy kid syndrome …”

“…D‐lactate can be effectively measured by unique methods including: D‐lactate‐specific enzymatic techniques (such as with D‐lactate dehydrogenase), gas chromatography, high‐performance liquid chromatography, or capillary electrophoresis . The majority of these methods require specialized laboratories and personnel, but automated methods of D‐lactate measurement are becoming increasingly available …”

“…17 Both D-and L-lactate are readily produced in ruminant species during the fermentation of carbohydrates by ruminal flora, 322 and encephalopathy from D-lactic acidosis is well-documented due to grain overload, ruminal acidosis, calf diarrhea, drunken lamb syndrome, and floppy kid syndrome. 322,[330][331][332][333][334][335][336] Increased D-lactate concentrations have been documented in cats with diabetic ketoacidosis (mean ± SD: 0.37 ± 0.07 mmol/L [3.3 ± 0.6 mg/dL]), 331 propylene glycol intoxication (up to 7.1 mmol/L [64.0 mg/dL]), 284 exocrine pancreatic insufficiency (17.7 mmol/L [159.5 mg/dL]), 337…”

“…385 The majority of these methods require specialized laboratories and personnel, but automated methods of D-lactate measurement are becoming increasingly available. 386,387 Interference Rapid infusion of lactated Ringer's solution (LRS) has the potential to affect plasma lactate concentrations. Lactate concentrations remained within the reference interval in healthy adult dogs treated with LRS at 2 mL/kg/h for 12 hours, and at 10 mL/kg/h for 1 hour.…”