D-lactic acidosis presenting as metabolic encephalopathy in a patient with short bowel syndrome

• Published in: BMJ case reports Vol. 14; no. 5; p. e241102
• Main Authors: McHale, Ciarán, Keating, Eoin, O'Donovan, Helen, Slattery, Eoin
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 13.05.2021; BMJ Publishing Group
• Subjects: Acidosis; Acidosis, Lactic - diagnosis; Acidosis, Lactic - etiology; Antibiotics; Bioavailability; Brain Diseases, Metabolic - diagnosis; Brain Diseases, Metabolic - etiology; Carbohydrates; Case Report; Case reports; Electrolytes; Humans; Intensive care; Laboratories; Metabolism; Metabolites; Patients; Short Bowel Syndrome - complications; Short Bowel Syndrome - therapy; Small intestine; Vitamin deficiency; malabsorption; fluid electrolyte and acid-base disturbances; gastroenterology
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-241102

We present a case of D-lactic acidosis presenting as a metabolic encephalopathy secondary to small intestinal bacterial overgrowth. This patient had a known history of short bowel syndrome. Of note, this case required the alteration of treatment to promote a sustained clinical and biochemical improvement. We discuss the pathophysiological mechanisms thought to be involved. We also review the current therapies as well as potential future strategies. This case highlights the importance of the prompt clinical recognition of signs and symptoms as well as the rapid initiation of management strategies to ameliorate this condition.