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High anion gap metabolic acidosis caused by D-lactate: mind the time of blood collection.

Authors
  • Weemaes, Matthias1
  • Hiele, Martin2
  • Vermeersch, Pieter1, 3
  • 1 Clinical Department of Laboratory Medicine, UZ Leuven, Leuven, Belgium. , (Belgium)
  • 2 Clinical Department of Gastroenterology, UZ Leuven, Leuven, Belgium. , (Belgium)
  • 3 Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium. , (Belgium)
Type
Published Article
Journal
Biochemia medica
Publication Date
Feb 15, 2020
Volume
30
Issue
1
Pages
11001–11001
Identifiers
DOI: 10.11613/BM.2020.011001
PMID: 31839728
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

D-lactic acidosis is an uncommon cause of high anion gap acidosis. A 35-year old woman was admitted to the emergency room with somnolence, drowsiness, dizziness, incoherent speech and drunk appearance. Her past medical history included a Roux-en-Y bypass. Point-of-care venous blood analysis revealed a high anion gap acidosis. Based on the clinical presentation, routine laboratory results and negative toxicology screening, D-lactate and 5-oxoprolinuria were considered as the most likely causes of the high anion gap acidosis. Urine organic acid analysis revealed increased lactate, but no 5-oxoproline. Plasma D-lactate was < 1.0 mmol/L and could not confirm D-lactic acidosis. Further investigation revealed that the blood sample for D-lactate was drawn 12 hours after admission, which might explain the false-negative result. Data regarding the half-life of D-lactate are, however, scarce. During a second admission, one month later, D-lactic acidosis could be confirmed with an anion gap of 40.7 mmol/L and a D-lactate of 21.0 mmol/L measured in a sample collected at the time of admission. The time of blood collection is of utmost importance to establish the diagnosis of D-lactic acidosis due to the fast clearance of D-lactate in the human body. Croatian Society of Medical Biochemistry and Laboratory Medicine.

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