D-Lactic acidosis - A review of clinical presentation, biochemical features, and pathophysiologic mechanisms

被引:209
作者
Uribarri, J
Oh, MS
Carroll, HJ
机构
[1] CUNY, Mt Sinai Med Ctr, Dept Med, New York, NY 10029 USA
[2] SUNY Hlth Sci Ctr, Dept Med, Brooklyn, NY 11203 USA
关键词
D O I
10.1097/00005792-199803000-00001
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
This report describes a case of d-lactic acidosis observed by the authors and then reviews all case reports of d-lactic acidosis in the literature in order to define its clinical and biochemical features and pathogenetic mechanisms. The report also reviews the literature on metabolism of d-lactic acid in humans. The clinical presentation of d-lactic acidosis is characterized by episodes of encephalopathy and metabolic acidosis. The diagnosis should be considered in a patient who presents with metabolic acidosis and high serum anion gap, normal lactate level, negative Acetest, short bowel syndrome or other forms of malabsorption, and characteristic neurologic findings. Development of the syndrome requires the following conditions 1) carbohydrate malabsorption with increased delivery of nutrients to the colon, 2) colonic bacterial flora of a type that produces d-lactic acid, 3) ingestion of large amounts of carbohydrate, 4) diminished colonic motility, allowing time for nutrients in the colon to undergo bacterial fermentation, and 5) impaired d-lactate metabolism. In contrast to the initial assumption that d-lactic acid is not metabolized by humans, analysis of published data shows a substantial rate of metabolism of d-lactate by normal humans. Estimates based on these data suggest that impaired metabolism of d-lactate is almost a prerequisite for the development of the syndrome.
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页码:73 / 82
页数:10
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