TY - JOUR
T1 - d-lactate encephalopathy
AU - Thurn, Joseph R.
AU - Pierpont, Gordon L.
AU - Ludvigsen, Carl W.
AU - Eckfeldt, John H.
PY - 1985/12
Y1 - 1985/12
N2 - Although d-lactate is not a product of human intermediary metabolism, absorption of d-lactate produced by abnormal intestinal bacteria can cause systemic acidosis in patients who have undergone gastrointestinal surgery, particularly jejunoileal bypass. In order to learn more about the prevalence of d-lactate encephalopathy, its occurrence in other disorders, and how well D-lactate concentration correlates with clinical symptoms, serum D-lactate levels were determined in several specific populations. d-lactate was undetectable (less than 0.5 mmol/liter) in 72 healthy volunteers and 57 obese persons. In 33 patients who had jejunoileal bypass, 16 reported symptoms consistent with d-lactate encephalopathy since surgery. Nine of these 16 had d-lactate levels greater than 0.5 mmol/liter (range 0.7 to 11.5 mmol/liter). Levels of, d-lactate fluctuated over time, and in two patients, markedly elevated levels correlated with an encephalopathy accompanied by hyperchloremic metabolic acidosis and elevated anion gap. In 470 randomly chosen hospitalized patients, d-lactate level greater than 0.5 mmol/ liter was found in 13 (2.8 percent), and 60 percent of these had a history of gastrointestinal surgery or disease. It is concluded that elevated serum D-lactate levels are relatively common in patients with jejunoileal bypass, and although more rare, occur in other gastrointestinal disorders as well. The symptoms of D-lactate encephalopathy are quite sensitive, but not necessarily specific for this disorder.
AB - Although d-lactate is not a product of human intermediary metabolism, absorption of d-lactate produced by abnormal intestinal bacteria can cause systemic acidosis in patients who have undergone gastrointestinal surgery, particularly jejunoileal bypass. In order to learn more about the prevalence of d-lactate encephalopathy, its occurrence in other disorders, and how well D-lactate concentration correlates with clinical symptoms, serum D-lactate levels were determined in several specific populations. d-lactate was undetectable (less than 0.5 mmol/liter) in 72 healthy volunteers and 57 obese persons. In 33 patients who had jejunoileal bypass, 16 reported symptoms consistent with d-lactate encephalopathy since surgery. Nine of these 16 had d-lactate levels greater than 0.5 mmol/liter (range 0.7 to 11.5 mmol/liter). Levels of, d-lactate fluctuated over time, and in two patients, markedly elevated levels correlated with an encephalopathy accompanied by hyperchloremic metabolic acidosis and elevated anion gap. In 470 randomly chosen hospitalized patients, d-lactate level greater than 0.5 mmol/ liter was found in 13 (2.8 percent), and 60 percent of these had a history of gastrointestinal surgery or disease. It is concluded that elevated serum D-lactate levels are relatively common in patients with jejunoileal bypass, and although more rare, occur in other gastrointestinal disorders as well. The symptoms of D-lactate encephalopathy are quite sensitive, but not necessarily specific for this disorder.
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U2 - 10.1016/0002-9343(85)90522-4
DO - 10.1016/0002-9343(85)90522-4
M3 - Article
C2 - 4073108
AN - SCOPUS:0022340427
VL - 79
SP - 717
EP - 721
JO - American Journal of Medicine
JF - American Journal of Medicine
SN - 0002-9343
IS - 6
ER -