d -lactic acidosis 23 years after jejuno-ileal bypass

Narula, Rajesh K.; Shafei, Amr El; Ramaiah, Dinesh; Schmitz, Paul G.

doi:10.1053/ajkd.2000.9005

Cited by 37 publications

(28 citation statements)

References 13 publications

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“…The common occurrence of normal anion gap acidosis in d-lactic acidosis has been attributed to efficient excretion of the d-lactate anion with sodium during the course of the disorder. As described previously, d-lactate excretion is relatively high because the renal tubular lactate transporter binds d-lactate less well than l-lactate, the reabsorption of the d-isomer being substantially lower (renal threshold Ͻ1 mmol/L (60,61).…”

Section: Ratio Of Change In Unmeasured Anion Concentration and Changementioning

confidence: 79%

“…The ⌬AG/⌬HCO 3 Ϫ in d-lactic acidosis in many studies has been found to be more variable than in l-lactic acidosis (60,61). Consistent with this variability, various types of metabolic acidosis can be found, including high anion gap, mixed high anion gap, and normal anion gap acidosis, or normal anion gap acidosis alone (60,61). The common occurrence of normal anion gap acidosis in d-lactic acidosis has been attributed to efficient excretion of the d-lactate anion with sodium during the course of the disorder.…”

Section: Ratio Of Change In Unmeasured Anion Concentration and Changementioning

confidence: 99%

“…Similarly, the more frequent occurrence of hyperchloremic acidosis in d-lactic acidosis compared with l-lactic acidosis has been attributed to greater loss of d-lactate in the urine. The renal tubular lactate transporter binds the isomer d-lactate substantially less well than l-lactate; therefore, the reabsorption of the d-isomer is substantially lower, causing much greater urinary loss of dlactate (60,61).…”

Section: High Serum Anion Gapmentioning

confidence: 99%

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Serum Anion Gap

Kraut

Madias

2007

Clinical Journal of the American Society of Nephrology

333

257

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The serum anion gap, calculated from the electrolytes measured in the chemical laboratory, is defined as the sum of serum chloride and bicarbonate concentrations subtracted from the serum sodium concentration. This entity is used in the detection and analysis of acid-base disorders, assessment of quality control in the chemical laboratory, and detection of such disorders as multiple myeloma, bromide intoxication, and lithium intoxication. The normal value can vary widely, reflecting both differences in the methods that are used to measure its constituents and substantial interindividual variability. Low values most commonly indicate laboratory error or hypoalbuminemia but can denote the presence of a paraproteinemia or intoxication with lithium, bromide, or iodide. Elevated values most commonly indicate metabolic acidosis but can reflect laboratory error, metabolic alkalosis, hyperphosphatemia, or paraproteinemia. Metabolic acidosis can be divided into high anion and normal anion gap varieties, which can be present alone or concurrently. A presumed 1:1 stoichiometry between change in the serum anion gap (⌬AG) and change in the serum bicarbonate concentration (⌬HCO 3 ؊ ) has been used to uncover the concurrence of mixed metabolic acid-base disorders in patients with high anion gap acidosis. However, recent studies indicate variability in the ⌬AG/⌬HCO 3 ؊ in this disorder. This observation undercuts the ability to use this ratio alone to detect complex acid-base disorders, thus emphasizing the need to consider additional information to obtain the appropriate diagnosis. Despite these caveats, calculation of the serum anion gap remains an inexpensive and effective tool that aids detection of various acid-base disorders, hematologic malignancies, and intoxications.

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Section: Ratio Of Change In Unmeasured Anion Concentration and Changementioning

confidence: 79%

Section: Ratio Of Change In Unmeasured Anion Concentration and Changementioning

confidence: 99%

Section: High Serum Anion Gapmentioning

confidence: 99%

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Serum Anion Gap

Kraut

Madias

2007

Clinical Journal of the American Society of Nephrology

333

257

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“…Few reports of encephalopathy characterized by episodes of confusion, behavioral abnormalities, weakness, lethargy, ataxia and dysarthria in association with D-lactic acidosis have been described after jujenoileostomy. [39][40][41][42][43] The neurological symptoms often precipitated after high carbohydrate diets and believed to result from fermentation of carbohydrates in the colon or bypassed segment of the small bowel resulting in elevated levels of D-lactate. Although severe metabolic acidosis was considered to be associated with this condition, the serum chemistries and absence of anion gap may be misleading.…”

Section: 35mentioning

confidence: 99%

“…Although severe metabolic acidosis was considered to be associated with this condition, the serum chemistries and absence of anion gap may be misleading. 42 Diagnosis is established by marked increase in D-lactate concentration in serum and urine. It is of note that most laboratories routinely check L-lactate and do not check the D-lactate levels.…”

Section: 35mentioning

confidence: 99%

An overview of complications affecting the Central Nervous System following bariatric surgery

Zafar

Khatri

2018

NSJ

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Bariatric surgery has been considered as an effective treatment for morbid obesity. Apart from procedures related complications, a broad spectrum of neurological disorders affecting any part of neuraxis has been reported following BS. Central nervous system complications, although less common than peripheral nervous system complications, carry significant morbidity and potential mortality. Encephalopathy, behavioral and psychiatric disorders, myelopathy and optic neuropathy are the most frequently reported CNS complications. Early detection and prompt management may improve or completely reverse these neurological complications. It is essential that the treating physicians must be aware of their clinical manifestations and management, so early diagnosis and treatment can prevent patients from suffering significant neurological deficits and even death. This review discusses the clinical manifestations of these complications in detail which will help concerned physician in earlier recognition and hence prevent the delay in specific treatment.

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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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d -lactic acidosis 23 years after jejuno-ileal bypass

Cited by 37 publications

References 13 publications

Serum Anion Gap

Serum Anion Gap

An overview of complications affecting the Central Nervous System following bariatric surgery

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

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