D-Lactic Acidosis After Jejunoileal Bypass: Identification of Organic Anions by Nuclear Magnetic Resonance Spectroscopy
Authors: MORRIS TRAUBE
Journal: Annals of Internal Medicine (1983)

Short Papers1 February 1983D-Lactic Acidosis After Jejunoileal Bypass: Identification of Organic Anions by Nuclear Magnetic Resonance SpectroscopyMORRIS TRAUBE, M.D., JAY L. BOCK, M.D.; Ph.D., JAMES L. BOYER, M.D.MORRIS TRAUBE, M.D.Search for more papers by this author, JAY L. BOCK, M.D.; Ph.D.Search for more papers by this author, JAMES L. BOYER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-98-2-171 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptA 40-year-old man with jejunoileal bypass developed a syndrome of bizarre behavior, slurred speech, ataxic gait, and inappropriate affect, associated with a metabolic acidosis characterized by an increase in the anion gap. SerumL-lactate level was normal, but high-resolution proton nuclear magnetic resonance spectrums of the patient's serum showed a high concentration of lactate. A diagnosis ofD-lactic acidosis was confirmed by a specific enzymatic assay forD-lactate. TheD-lactic acidosis was cleared using antibiotic therapy, suggesting thatD-lactate is produced from fermentation of ingested carbohydrate by colonic bacteria. Nuclear magnetic resonance spectroscopy is a rapid screening test for identifying...References1. OHCARROLL MH. The anion gap. N Engl J Med. 1977;297:814-7. CrossrefMedlineGoogle Scholar2. GABOWKAEHNYFENNESSEYGOODMANGROSSSCHRIER PWPSPR. Diagnostic importance of an increased serum anion gap. N Engl J Med. 1980;303:854-8. CrossrefMedlineGoogle Scholar3. OHPHELPSTRAUBEBARBOSA-SALDIVARBOXHILLCARROLL MKMJCH. D-Lactic acidosis in a man with the short-bowel syndrome. N Engl J Med. 1979;301:249-52. CrossrefMedlineGoogle Scholar4. HAINESBAKERBOYER NJJ. Prognostic indicators of hepatic injury following jejunoileal bypass performed for refractory obesity: a prospective study. Hepatology. 1981;1:161-7. CrossrefMedlineGoogle Scholar5. 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