treatment of D-Lactic acidosis

Q: What is the treatment of D-Lactic acidosis?

Answer: D-lactate is a byproduct of bacterial metabolism and may accumulate in patients with short-gut syndrome. It is a common finding in patients with history of gastric bypass or small-bowel resection. Bacteria metabolize glucose and carbohydrate to D-lactic acid, which is then systemically absorbed. D-lactate is slowly metabolized by human subjects, and accumulate in patients with short guts. It is clinically a benign condition.

Treatment consists of

• restriction of simple sugars,
• hydration,
• bicarbonate administration if severe acidosis

Use of metronidazole or rifaximin has been described but it is controversial as antibiotics can make the syndrome worse by permitting overgrowth of lactobacilli.

References:

1. Uribarri J, Oh MS, Carroll HJ: D-Lactic acidosis. Medicine 77:73 -82, 1998

2. Coronado BE, Opal SM, Yoburn DC: Antibiotic-induced D-lactic acidosis. Ann Intern Med 122:839 -842, 1995