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Effect of Parenteral Nutrition and Enteral Feeding on D-Lactic Acidosis in a Patient with Short Bowel

Department of Medicine, University of Washington, Seattle, Washington

Rebecca L. Rettmer, M.T.

Department of Medicine, University of Washington, Seattle, Washington

Edward W. Lipkin, M.D., PH.D.

Department of Medicine, University of Washington, Seattle, Washington

D-Lactic acid can accumulate in blood in some patients with intestinal failure, leading to a clinical syndrome of severe acidosis and encephalopathy. The possible impact of parenteral nutrition on its clinical course has not been established. One patient with a severe short-bowel syndrome supported by long-term parenteral nutrition who suffered repeated episodes of ataxia and disorientation associated with elevated serum levels of D-lactate was studied. Results demonstrated no impact of glucose- vs lipid-based parenteral nutrition formulations on total acid production or serum D-lactic acid levels, increased serum D-lactate levels during administration of neomycin, but prompt resolution of both acidosis and clinical symptoms with discontinuation of oral intake. This study confirms the findings of other investigators that D-lactic acidosis may be a significant, heretofore unappreciated complication in patients with severe short-bowel syndrome, and that prompt resolution may be effected with abrupt discontinuation of oral intake. Furthermore, the present study suggests neither a detrimental nor a beneficial effect of parenteral nutrition on this syndrome. (Journal of Parenteral and Enteral Nutrition 11:586-589, 1987)

Journal of Parenteral and Enteral Nutrition, Vol. 11, No. 6, 586-589 (1987)
DOI: 10.1177/0148607187011006586


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