Severe illness caused by the products of bacterial metabolism in a child with a short gut

Abstract

An 8-year-old boy with a short gut had six episodes of metabolic acidosis and neurological dysfunction over a 1 month period. The neurological features consisted of a depressed conscious state, confusion, aggressive behaviour, slurred speech and ataxia. The organic acid profile of urine demonstrated increased amounts of lactic, 3-hydroxypropionic, 3-hydroxyisobutyric, 2-hydroxyisocaproic, phenyllactic, 4-hydroxyphenylacetic and 4-hydroxyphenyllactic acids. Of the lactic acid 99% was D-lactic acid. The anaerobic gut flora consisted almost entirely of Lactobacilli in unusually large numbers. A course of vancomycin prevented further episodes. A urinary organic acid profile may be diagnostic when a person with a short gut develops metabolic acidosis or an unusual encephalopathy and bacterial metabolites should be considered in other patients with unusual combinations of organic acids in the urine.

Small intestinal bacterial overgrowth in children with intestinal failure on home parenteral nutrition

“…Different urinary tests have been used as indirect or surrogate markers for SIBO by detecting bacterial metabolites, indicating abnormal bacterial colonization in the small intestine (e.g. urinary phenol, indican, Cholyl‐PABA, and 4‐hydroxyphenylacetic acid) . Acetate, lactate, and formate have been shown to be significantly higher in upper gut aspirates of people with malabsorption syndrome and SIBO compared with malabsorption syndrome alone or a control group .…”

Shoshin beriberi mimicking central line sepsis in a child with short bowel syndrome

“…D-lactic acidosis secondary to bacterial overgrowth was also considered in the differential diagnosis, for it had been previously reported in a short gut patient who presented with severe metabolic acidosis and lethargy. [17] The treatment is typically enteral antibiotic therapy; however, intravenous antibiotics would also be indicated in someone with septic shock. Our patient failed to respond to this management.…”

Examining clinical similarities between myalgic encephalomyelitis/chronic fatigue syndrome and d-lactic acidosis: a systematic review

“…The dysbiosis is distinguished by an increased colonisation of lactic acid-producing bacteria, particularly bacteria that produce d -lactate (e.g., Lactobacillus fermenti, L acidophilus, and Streptococcus ; see review by Petersen [13]). An overgrowth of Lactobacilli has been identified in SBS patients with increased d -lactate levels [26, 28, 37, 47, 64, 68, 72, 74, 75, 103]. This dysbiosis has been proposed as a result of an impaired small intestine, either due to congenital causes, surgery for midgut volvulus, gangrene or inflammatory bowel disease [104]; functional SBS and carbohydrate malabsorption [32, 36]; or colonic stagnation [62].…”

“…Selected Bifidobacterium ( Bifidobacterium adolescentis, Bifidobacterium breve ) and Lactobacillus ( L. plantarum, L. salivarius, L. casei subspecies rhamnosus, L. delbrueckii subsp. Lactis, L. acidophilus, L. fermentum, L. buchneri ) species have been identified as predominant in patients with d -la [26, 28, 29, 37, 47, 54, 64, 68, 74, 75, 145]. Similarity between species identified as overgrown in d -la patients and those used in probiotic studies could also generate skepticism about the relevance of d -lactate theory for ME/CFS.…”