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

Ciarán McHale; Eoin Keating; Helen O'Donovan; Eoin Slattery

doi:10.1136/bcr-2020-241102

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

BMJ Case Rep. 2021 May 13;14(5):e241102. doi: 10.1136/bcr-2020-241102.

Authors

Ciarán McHale¹, Eoin Keating², Helen O'Donovan², Eoin Slattery²

Affiliations

¹ Department of Gastroenterology, Galway University Hospital, Galway, Ireland [email protected].
² Department of Gastroenterology, Galway University Hospital, Galway, Ireland.

Abstract

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.

Keywords: fluid electrolyte and acid-base disturbances; gastroenterology; malabsorption.

Publication types

Case Reports

MeSH terms

Acidosis, Lactic* / diagnosis
Acidosis, Lactic* / etiology
Brain Diseases, Metabolic* / diagnosis
Brain Diseases, Metabolic* / etiology
Humans
Short Bowel Syndrome* / complications
Short Bowel Syndrome* / therapy