| Download the amazing global Makindo app: Android | Apple | |
|---|---|
| MEDICAL DISCLAIMER: Educational use only. Not for diagnosis or management. See below for full disclaimer. |
D-lactic acidosis or D-lactate encephalopathy
🧪 D-lactic acidosis presents with recurrent episodes of encephalopathy and high-anion gap metabolic acidosis, particularly in patients with short bowel syndromes.
📌 About
- 🌀 D-lactate is a stereoisomer of the usual L-lactate.
- Only L-lactic acid is normally produced and metabolised in humans.
- Accumulation of D-lactate leads to neurotoxicity and acidosis.
🧬 Aetiology
- Short bowel syndrome (e.g. multiple resections).
- Malabsorption or jejuno-ileal bypass surgery.
- Excess carbohydrates reaching the colon → fermentation by gut bacteria → overproduction of D-lactate.
🧠 Clinical Features
- Stupor, delirium, ataxia, slurred speech.
- Episodes of inebriation-like behaviour, sometimes mistaken for intoxication.
- Can progress to psychosis or coma if untreated.
- Symptoms often episodic, triggered by high-carbohydrate intake.
🔎 Investigations
- ABG: High anion gap metabolic acidosis.
- Standard lactate assays only measure L-lactate ❌.
- Special assay required: D-lactate concentration >3 mmol/L confirms diagnosis ✅.
💊 Management
- IV fluids + sodium bicarbonate to correct acidaemia (❌ avoid lactated Ringer’s as it contains both D- and L-lactate).
- During acute episodes: restrict enteral carbohydrates → starves lactate-producing bacteria.
- Parenteral carbohydrate nutrition if required, with thiamine supplementation (prevents Wernicke-like syndromes by supporting pyruvate metabolism).
- Gut-acting antibiotics (poorly absorbed): clindamycin, vancomycin, neomycin, kanamycin.
- Haemodialysis: can rapidly clear D-lactate in severe cases.
📚 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
|
|
Categories
- A Level
- About
- Acute Medicine
- Anaesthetics and Critical Care
- Anatomy
- Anatomy and Physiology
- Biochemistry
- Book
- Cardiology
- Collections
- CompSci
- Crib Sheets
- Crib sheets
- Dental
- Dermatology
- Differentials
- Drugs
- ENT
- Education
- Electrocardiogram
- Embryology
- Emergency Medicine
- Endocrinology
- Ethics
- Foundation Doctors
- GCSE
- Gastroenterology
- General Practice
- Genetics
- Geriatric Medicine
- Guidelines
- Gynaecology
- Haematology
- Hepatology
- Immunology
- Infectious Diseases
- Infographic
- Investigations
- Lists
- Mandatory Training
- Medical Students
- Microbiology
- Nephrology
- Neurology
- Neurosurgery
- Nutrition
- OSCE
- OSCEs
- Obstetrics
- Obstetrics Gynaecology
- Oncology
- Ophthalmology
- Oral Medicine and Dentistry
- Orthopaedics
- Paediatrics
- Palliative
- Pathology
- Pharmacology
- Physiology
- Procedures
- Psychiatry
- Public Health
- Radiology
- Renal
- Respiratory
- Resuscitation
- Revision
- Rheumatology
- Statistics and Research
- Stroke
- Surgery
- Toxicology
- Trauma and Orthopaedics
- USMLE
- Urology
- Vascular Surgery