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Journal of Parenteral and Enteral Nutrition
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D-Lactate and Metabolic Bone Disease in Patients Receiving Long-Term Parenteral Nutrition

Mitchell A. Karton, M.D.

Department of Medicine, University of Washington, Seattle, Washington

Rebecca Rettmer, M.T. ASCP

Department of Medicine, University of Washington, Seattle, Washington

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

Department of Medicine, University of Washington, Seattle, Washington

Susan M. Ott, M.D.

Department of Medicine, University of Washington, Seattle, Washington

Alan Chait, M.D.

Department of Medicine, University of Washington, Seattle, Washington

D-lactate accumulates in some patients with malabsorption who continue oral intake of carbohydrate leading to a clinical syndrome of acidosis and encephalopathy. To assess the possibility that D-lactate contributes to acidosis and/ or metabolic bone disease in patients with malabsorption receiving long-term parenteral nutrition yet maintaining oral intake, D-lactate levels in serum and urine were measured in 14 long-term parenteral nutrition subjects (average duration of support 74 months) and 27 control subjects. Significant elevations in both serum and urine D-lactate were found in only two parenteral nutrition subjects. Both subjects with elevated D-lactate levels had bone pain, x-ray evidence of fractures, and biopsy evidence of osteomalacia. These studies suggest that D-lactate accumulation may be a heretofore unappreciated metabolic abnormality associated with metabolic bone disease and acidosis in patients with malabsorption who are supported by long-term parenteral nutrition. ( Journal of Parenteral and Enteral Nutrition 13:132-135, 1989)

Journal of Parenteral and Enteral Nutrition, Vol. 13, No. 2, 132-135 (1989)
DOI: 10.1177/0148607189013002132
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