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D-lactic acidosis in humans: systematic literature review

Authors
  • Bianchetti, Davide G. A. M.1
  • Amelio, Giacomo S.2
  • Lava, Sebastiano A. G.3
  • Bianchetti, Mario G.1
  • Simonetti, Giacomo D.1
  • Agostoni, Carlo2
  • Fossali, Emilio F.2
  • Milani, Gregorio P.2
  • 1 Pediatric Department of Southern Switzerland, Bellinzona, and Università della Svizzera Italiana, Lugano, Switzerland , Lugano (Switzerland)
  • 2 Università degli Studi di Milano, Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Milan, Italy , Milan (Italy)
  • 3 University Children’s Hospital of Bern, Department of Pediatrics, Inselspital, Bern, Switzerland , Bern (Switzerland)
Type
Published Article
Journal
Pediatric Nephrology
Publisher
Springer-Verlag
Publication Date
Dec 07, 2017
Volume
33
Issue
4
Pages
673–681
Identifiers
DOI: 10.1007/s00467-017-3844-8
Source
Springer Nature
Keywords
License
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Abstract

BackgroundD-lactic acidosis is an uncommon and challenging form of metabolic acidosis that may develop in short bowel syndrome. It has been documented exclusively in case reports and small case series.MethodsWe performed a review of the literature in the National Library of Medicine and Excerpta Medica databases.ResultsWe identified 84 original reports published between 1977 and 2017. D-lactic acidosis was observed in 98 individuals ranging in age from 7 months to 86 years with short bowel syndrome. The clinical presentation included Kussmaul breathing, confusion, slurred speech, and gait disturbances. Furthermore, among 99 consecutive patients with short bowel syndrome, 21 reported having episodes with symptoms consistent with D-lactic acidosis. In addition, D-lactic acid might also contribute to acidosis in diabetes mellitus. Finally, abnormally high D-lactic acid was documented after administration or ingestion of large amounts of propylene glycol, as paraneoplastic phenomenon and perhaps also in a so far poorly characterized inherited inborn error of metabolism.ConclusionsIn humans with short bowel syndrome (or carbohydrate malabsorption), D-lactic acidosis is likely rather common and under-recognized. This condition should be included in the differential diagnosis of unexplained high-gap metabolic acidosis where the anion causing the acidosis is not known. Furthermore, diabetic acidosis might be caused by accumulation of both ketone bodies and D-lactic acid. Finally, there are endogenous sources of D-lactic acid in subjects with propylene glycol intoxication.

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