Naslov
D-lactic acidosis: rare and potentially severe complication of short bowel syndrome

Autori
Čavlina Maša ; Ljubas-Kelečić Dina ; Barišić Ana ; Krznarić Željko

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, neobjavljeni rad, ostalo

Skup
UEG Week 2018

Mjesto i datum
Beč, Austrija, 20.10.2018. - 24.10.2018

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
D-lactic acidosis, short bowel syndrome
(D-lactic acidosis ; short bowel syndrome)

Sažetak
D-lactic acidosis is rare and highly underrecognized complication of short bowel syndrome (SBS). It is characterized by rapid development of neurological disturbances and high anion gap metabolic acidosis with normal L-lactate serum concentration. It is believed to be the result of colonic fermentation of malabsorbed carbohydrates predominantly in patients with SBS with colon in continuity. Since D-lactate concentration measurement is not routinely available, clinical diagnosis is of immense importance. We report our first case of D-lactic acidosis in 80-year old male patient. He presented to the emergency department with acute onset of weakness, slurred speech and gait disturbance. He had a history of SBS following a major small bowel resection for small bowel ischemia due to superior mesenteric artery occlusion, resulting in 30 cm of jejunum left and jejuno-transverse anastomosis formed. At the time of presentation he was on supplemental home parenteral nutrition for 1 year. Of comorbidities he had a history of arterial hypertension and chronic kidney disease. Initial workup revealed worsening of renal function (creatinine clearance 21.6 mL/min) and metabolic acidosis with increased anion gap and normal L–lactate values (Table 1). Since other causes of high anion gap metabolic acidosis were excluded, as well as other potential causes of acute onset neurological symptoms patient was diagnosed with highly probable D–lactic acidosis. He recovered well after treatment with intravenous sodium bicarbonate, thiamine supplementation, hydration, diet modification and oral metronidazole. D-lactic acidosis in our patient was the consequence of bacterial overgrowth, but also renal impairment that reduced the excretion of D-lactate. Since the condition is generally rare and its diagnosis by standard lactate assays is often not possible it is important to educate health- care practitioners how to recognize it and prevent its further incidence.

Izvorni jezik
Engleski

Znanstvena područja
Biotehnologija u biomedicini (prirodno područje, biomedicina i zdravstvo, biotehničko područje)

POVEZANOST RADA