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D Lactate Acidosis Treatment

D-lactate Producing Probiotic Strains In Chronic Fatigue Syndrome

D-lactate Producing Probiotic Strains In Chronic Fatigue Syndrome

D-Lactate producing probiotic strains in Chronic Fatigue Syndrome There appears to be a growing concern surrounding the use of probiotic species which produce some D-lactic acid , as opposed to solely L-lactic acid or other acid types (e.g. butyric, propionic, acetic and succinic acids). Limited human evidence exists on this topic, however a clear combination of symptoms do appear to be caused by the presence of excess D-lactic acid in the system. These symptoms tend to resemble those of chronic fatigue syndrome (CFS), with myalgia and mood and cognitive changes. Despite the most noted cases of acidosis occurring in individuals with short bowel syndrome, it has been hypothesised that this situation of acidity may arise in other circumstances, as a result of microbial imbalance within the gastrointestinal tract (GIT). Lactic acid can be produced by certain microorganisms as either L-lactic acid or its stereoisomer D-lactic acid. The theory behind the acidosis concern is that L-lactic acid can be metabolised and utilised by the mitochondria for energy production, whilst humans tend to lack sufficient levels of the enzyme D-lactate dehydrogenase required to utilise D-lactic acid. Instead, when high amounts of D-lactic acid accumulate in the gut, altering the pH, gut integrity may be compromised and the acid allowed passage into the body. When D-lactic acid then enters the cell, it can be preferentially taken up in the place of L-lactic acid, compromising mitochondrial function, leading to toxicity, acidity and resultant symptoms. Controversy still exists around this story, however, as research has revealed that despite this past hypothesis, most humans do produce D-lactate dehydrogenase and only a very small portion of the population are unable to.[1] Specific microbial s Continue reading >>

D-lactic Acidosis: An Underrecognized Complication Of Short Bowel Syndrome

D-lactic Acidosis: An Underrecognized Complication Of Short Bowel Syndrome

D-Lactic Acidosis: An Underrecognized Complication of Short Bowel Syndrome Department of Medicine, Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT 06102, USA Received 26 November 2014; Revised 28 March 2015; Accepted 8 April 2015 Copyright 2015 N. Gurukripa Kowlgi and Lovely Chhabra. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. D-lactic acidosis or D-lactate encephalopathy is a rare condition that occurs primarily in individuals who have a history of short bowel syndrome. The unabsorbed carbohydrates act as a substrate for colonic bacteria to form D-lactic acid among other organic acids. The acidic pH generated as a result of D-lactate production further propagates production of D-lactic acid, hence giving rise to a vicious cycle. D-lactic acid accumulation in the blood can cause neurologic symptoms such as delirium, ataxia, and slurred speech. Diagnosis is made by a combination of clinical and laboratory data including special assays for D-lactate. Treatment includes correcting the acidosis and decreasing substrate for D-lactate such as carbohydrates in meals. In addition, antibiotics can be used to clear colonic flora. Although newer techniques for diagnosis and treatment are being developed, clinical diagnosis still holds paramount importance, as there can be many confounders in the diagnosis as will be discussed subsequently. D-lactic acidosis (D-la) is a rare form of lactic acidosis seen mostly in patients with short bowel syndrome (SBS). Other conditions implicated are toxic ingestions of chemicals such as propylene glycol and rarely in patients with severe diabetic Continue reading >>

Newsletter: D-lactic Acidosis

Newsletter: D-lactic Acidosis

AddthisShare | Facebook Twitter Pinterest Gmail var addthis_exclude = 'print, email'; D-Lactic Acidosis Craig Petersen RD, CNSC D-lactic acidosis, also referred to as D-lactate encephalopathy, is a rare neurological syndrome that can occur in individuals with short bowel syndrome (SBS) or following jejuno-ileal bypass surgery. A home parenteral or enteral nutrition (HPEN) consumer may develop the neurological symptoms—which can be quite striking—several months to years after the initial diagnosis of a malabsorption disorder. Misdiagnosis of D-lactic acidosis is common, as the neurologic symptoms are sometimes attributed to other causes. With proper diagnosis, D-lactic acidosis can be treated promptly and the symptoms will usually resolve within several hours to a few days. Symptoms Neurological symptoms associated with this syndrome typically present after the ingestion of enteral formula or food high in carbohydrates (either simple or complex) and include altered mental status, slurred speech, confusion, disorientation, difficulty concentrating, memory deficits, excessive sleepiness, weakness, abnormal gait, problems with muscle coordination, and even coma. Individuals with D-lactic acidosis often appear to be inebriated, or drunk, though they may not have consumed alcohol and alcohol is not detected in the blood. Behavior during episodes of D-lactic acidosis can be aggressive, hostile, or abusive. Neurological symptoms are episodic and may last from hours to days. They are accompanied by metabolic acidosis and elevation of plasma D-lactic acid (also referred to as D-lactate) concentration. Cause In D-lactic acidosis, carbohydrate that is not properly absorbed is fermented by an abnormal bacterial flora in the colon. This fermentation produces excessive amounts of Continue reading >>

D-lactate Free Probiotics Frequently Asked Questions

D-lactate Free Probiotics Frequently Asked Questions

D-lactate free probiotics Frequently asked questions Q. I noticed that GutPro contains L. plantarum that is not D-lactate free. Why? A. GutPro contains L. plantarum for a very good reason. It has actually been proven to reverse acidosis.L. plantarum initially produces L(+)-lactate, and then switches to producing D(-)-lactate, allowing for equilibrium to be reached. The production of D(-)-lactate in L. plantarum is linked to the biosynthesis of the cell wall. Q. What about L. salavarius? Is this strain D-lactate free? A. L. salavarius primarily produces L-lactate and this is why it commonly referred to as d-lactate free. But, in reality it does produce a small amount of D-lactate. No studies have shown that this strain has ever caused acidosis. The case is similar withL. gasseri, which predominantly makes L(+)-lactate during the growth phase and switches to D(-)-lactate when the growth cycle plateaus. Q. I heard that probiotics that contain D-lactate producing strains cause acidosis. A. Just because a strain produces D-lactate does not mean that it will contribute to acidosis. GUTPro is formulated with L. plantarum which produces both D-lactate and L-lactate. L. plantarum has actually been proven to reverse acidosis. Q. Isnt it true that some probiotics can cause D-lactic acidosis? A. Yes. Several studies have shown that L. acidophilus has caused acidosis in individuals with compromised digestive systems. That is why GutPro was specifically designed without this popular strain of probiotic. A. D-lactic acidosis occurs when the body is unable to properly metabolize excess D(-)-lactate. Q. What are the symptoms of D-lactic acidosis? A. Impaired mental status is a universal feature in D-lactic acidosis. Some of the common neurological symptoms include: Aggressive or hostil Continue reading >>

Lactic Acidosis Treatment & Management

Lactic Acidosis Treatment & Management

Approach Considerations Treatment is directed towards correcting the underlying cause of lactic acidosis and optimizing tissue oxygen delivery. The former is addressed by various therapies, including administration of appropriate antibiotics, surgical drainage and debridement of a septic focus, chemotherapy of malignant disorders, discontinuation of causative drugs, and dietary modification in certain types of congenital lactate acidosis. Cardiovascular collapse secondary to hypovolemia or sepsis should be treated with fluid replacement. Both crystalloids and colloids can restore intravascular volume, but hydroxyethyl starch solutions should be avoided owing to increased mortality. [21] Excessive normal saline administration can cause a nongap metabolic acidosis due to hyperchloremia, which has been associated with increased acute kidney injury. [32] Balanced salt solutions such as Ringer lactate and Plasma-Lyte will not cause a nongap metabolic acidosis and may reduce the need for renal replacement therapy; however, these can cause a metabolic alkalosis. [33] No randomized, controlled trial has yet established the safest and most effective crystalloid. If a colloid is indicated, albumin should be used. Despite appropriate fluid management, vasopressors or inotropes may still be required to augment oxygen delivery. Acidemia decreases the response to catecholamines, and higher doses may be needed. Conversely, high doses may exacerbate ischemia in critical tissue beds. Careful dose titration is needed to maximize benefit and reduce harm. Lactic acidosis causes a compensatory increase in minute ventilation. Patients may be tachypneic initially, but respiratory muscle fatigue can ensue rapidly and mechanical ventilation may be necessary. Alkali therapy remains controversial Continue reading >>

What Is Lactic Acidosis?: Signs, Symptoms, Causes And Treatment

What Is Lactic Acidosis?: Signs, Symptoms, Causes And Treatment

What is lactic acidosis? It is a condition where lactate builds up in the body which leads to extremely low pH levels in the blood. Normally, your blood is alkaline or slightly basic. Lactic acidosis occurs when your blood is much more acidic than usual. Changes in blood pH levels can adversely affect your body’s organs. Lactic acidosis is a form of metabolic acidosis characterized by excessive accumulation of acid as a result of the body failing to metabolize lactic acidosis. Metabolic acidosis is a medical state that occurs when there is reduced systemic pH because of a decrease in bicarbonate or an increase in hydrogen ion concentration. Accumulation of lactic acids happens when there is inadequate oxygen in the muscles that is required to break down the glycogen and glucose for energy. In a normal body, lactate will exit muscle cells and travel to the liver, where it will be oxidized to pyruvate, and later converted to glucose. Glucose refers to a form of sugar which is one of the main sources of energy for the body. When there is reduced oxygen in the tissue, there will be a build up of lactic acid. This medical condition usually starts in the kidneys. Lactic acidosis normally occurs when the kidneys fail to excrete excess acids from the body. As a result, lactic acid accumulates in the body faster than it is removed. This build up of lactic acid leads to a pH imbalance in the body. There are two forms of lactic acid, that is D-lactate and L-lactate. D-lactate is a form produced in bacterial metabolism and may build up in patients who have had a gastric bypass or have short gut syndrome. On the other hand, L-lactic is produced from human metabolism. Both L-lactic and D-lactic are produced from pyruvate and metabolized to pyruvate by an enzyme known as lactate deh Continue reading >>

Approaches To Treating D-lactic Acidosis

Approaches To Treating D-lactic Acidosis

Has there been any effective approaches to treating D-Lactic Acidosis? I have tried B1 which I noticed was very helpful at first and made many of my symptoms go away but started to give me headaches after a few days... so now I am looking for other alternatives such as any recommended probiotics or other natural remedies that may help treat D-Lactic Acidosis. Your thoughts and suggestions are appreciated. I've been dealing with this recently and found some relief with an elemental diet. Interpretive Theurapeutics has one that taste fairly decent. It hasn't been a cure for the acidosis but it has helped me manage it better. I did two straight weeks of nothing but the formula then slowly started adding foods back. Also I assume you've tried oral baking soda? Have you looked into Custom Probiotics D-Lactate free formula? I've been dealing with this recently and found some relief with an elemental diet. Interpretive Theurapeutics has one that taste fairly decent. It hasn't been a cure for the acidosis but it has helped me manage it better. I did two straight weeks of nothing but the formula then slowly started adding foods back. Do you mean physicians' elemental diet from integrative therapeutics? I'm in the process of creating my own formula from scratch but am having difficulty finding a multivitamin that i can tolerate. I believe an elemental diet will reduce my Crohn's disease, high d-lactic acid and the overgrowth of clostridium as shown on the MSA test. I'm also pretty sure i have mild SIBO. Do you mean physicians' elemental diet from integrative therapeutics? I'm in the process of creating my own formula from scratch but am having difficulty finding a multivitamin that i can tolerate. I believe an elemental diet will reduce my Crohn's disease, high d-lactic acid and Continue reading >>

Lactic Acidosis – Fatigued, Confused, Grumpy? This Might Be Why.

Lactic Acidosis – Fatigued, Confused, Grumpy? This Might Be Why.

Many people with gut issues suffer from cogitative issues and body-wide symptoms, along with the gastrointestinal hell they’re going through. One of the reasons is often high levels of D-lactic acid. A few definitions acidosis – an abnormal decrease in pH levels. If systemic this is usually only a tenth of a pH level, or so, high. lactic acid (lactate) – an organic compound formed from fermentation, as well as by humans during normal metabolism and exercise. There are two main types discussed here D-lactic acid and L-lactic acid (two mirror-image isomers), DL-lactic acid is a mixture of the two in equal amounts. See Wikipedia for more information on D&L chirality prefixes. L-lactic acid – the type produced in the human body and the primary type found in the human diet. This form is easy for the body and rarely accumulates at a rate higher than the bodies ability to remove it. Short term acidosis is possible from l-lactic acid with extended strenuous exercise, but is usually cleared within a few hours. Acidosis can also occur with organ failure and other illness. D-lactic acid – this type is mostly foreign to the body and difficult to remove. It can easily build up, when it does this is called lactic acidosis. This article will refer it to as d-lactic acidosis to distinguish Lactate – In this context – the conjugate base of lactic acid, the two terms are used interchangeably. Lactic acid actually isn’t the real culprit that causes the fatigue, brain fog, etc. (see below for symptoms). When lactic acid is formed in the body (by us during exercise, or by bacteria) hydrogen ions are formed, hydrogen ions lower the pH (make it acidic), hydrogen is the true culprit. Excess hydrogen causes problems of its own, but the increased systemic acidity is what causes m Continue reading >>

Lactic Acidosis: What You Need To Know

Lactic Acidosis: What You Need To Know

Lactic acidosis is a form of metabolic acidosis that begins in the kidneys. People with lactic acidosis have kidneys that are unable to remove excess acid from their body. If lactic acid builds up in the body more quickly than it can be removed, acidity levels in bodily fluids — such as blood — spike. This buildup of acid causes an imbalance in the body’s pH level, which should always be slightly alkaline instead of acidic. There are a few different types of acidosis. Lactic acid buildup occurs when there’s not enough oxygen in the muscles to break down glucose and glycogen. This is called anaerobic metabolism. There are two types of lactic acid: L-lactate and D-lactate. Most forms of lactic acidosis are caused by too much L-lactate. Lactic acidosis has many causes and can often be treated. But if left untreated, it may be life-threatening. The symptoms of lactic acidosis are typical of many health issues. If you experience any of these symptoms, you should contact your doctor immediately. Your doctor can help determine the root cause. Several symptoms of lactic acidosis represent a medical emergency: fruity-smelling breath (a possible indication of a serious complication of diabetes, called ketoacidosis) confusion jaundice (yellowing of the skin or the whites of the eyes) trouble breathing or shallow, rapid breathing If you know or suspect that you have lactic acidosis and have any of these symptoms, call 911 or go to an emergency room right away. Other lactic acidosis symptoms include: exhaustion or extreme fatigue muscle cramps or pain body weakness overall feelings of physical discomfort abdominal pain or discomfort diarrhea decrease in appetite headache rapid heart rate Lactic acidosis has a wide range of underlying causes, including carbon monoxide poisoni Continue reading >>

D-lactic Acidosis With Encephalopathy Subsequent To Short Bowel Syndrome In Bariatric Surgery. A Case Report In Emergency Room

D-lactic Acidosis With Encephalopathy Subsequent To Short Bowel Syndrome In Bariatric Surgery. A Case Report In Emergency Room

D-lactic acidosis with encephalopathy subsequent to short bowel syndrome in bariatric surgery. A case report in emergency room Roberta Rocchi, MD Laura Magrini, MD Enrico Ferri Emergency Medicine Department, S. Andrea Hospital, Rome, Italy We describe the case of a patient admitted in Emergency Department with D-lactic acidosis associated to encephalopathy secondary to short bowel syndrome following bariatric surgery. D-lactic acidosis with encephalopathy is a severe complication of short bowel syndrome. It is characterized by metabolic acidosis due to increase of lactic acid determining neurological signs and symptoms of encephalopathy. In short bowel syndromes patients there is a malabsorption or lack of absorption of carbohydrates; this causes an accumulation of lactic acid that reduces pH and promotes bacterial growth, mainly lactobacillus, which in turn produce D-lactic acid (1,2). D-lactic acid is metabolized, and eliminated more difficult than L-lactic acid normally produced (2). Patients with short bowel syndrome secondary to intestinal bariatric surgery can show D-lactic acidosis from few months to several years after the surgery (2). Patients with D-lactic acidosis show neurological symptoms and signs as ataxia, difficulty speaking, nystagmus, asymmetry, memory loss, instability, irritability, sensorial alterations, stupor, and also coma. Female, 31 years old, arrived in our Emergency Room (ER) (transported by public ambulance) for sudden onset of fatigue, stupor, difficulty speaking, ideomotor slowing. Sympthomathology began in the morning. The patient underwent bariatric surgery in order to loose weight one year before presenting in ER. Her past history was negative. She suffered of vomiting and fever four days before the admission in our ER. In that occasi Continue reading >>

D-lactic Acidosis In Children With Short Bowel Syndrome: A Relevant Clinical Condition

D-lactic Acidosis In Children With Short Bowel Syndrome: A Relevant Clinical Condition

1Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy; 2Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom; 3Department of Paediatric Surgery, Donauspital, Vienna, Austria. Introduction: D-lactic acidosis (D-LA) is an uncommon complication in children with Short Bowel Syndrome (SBS). This condition is related to excess of production of D-lactate by intestinal bacteria when carbohydrates (CHO) are not completely absorbed in the small bowel. We retrospectively analyze the presentation of D-LA in children with SBS treated at the Royal Manchester Childrens Hospital. Methods: Thirty-five short bowel patients underwent autologous bowel reconstruction from January 2010 to January 2017. Data collected included population demographics, bowel length, antibiotic treatment, CHO intake. Eight children (23%) developed 23 episodes of D-LA in total during the study period. They all presented with neurological symptoms, fatigue and lethargy or behavioral changes. Two further children although symptomatic did not have high level of D-lactate. Results: All children enjoyed free diet and were on oral cyclical gut decontamination when developed D-LA. No children were on long term probiotics or symbiotic. The number and the severity of the D-LA episodes were not related to the length of the bowel or the age of the patients. The management of D-LA consisted in 24 hour of starvation with only oral/IV fluid intake allowed, slow re introduction of CHO and change of gut decontamination antibiotics. Conclusions: D-lactic acidosis is a rare but serious complication of SBS, which should be suspected in presence of neurological symptoms and behavioral changes. The aetiology of D-LA is still Continue reading >>

D-lactic Acidosis A Very Rare Form Of Metabolic Acidosis Explained

D-lactic Acidosis A Very Rare Form Of Metabolic Acidosis Explained

D-lactic acidosis a very rare form of metabolic acidosis explained Summarized from Kowgli N, Chhabra L. D-lactic acidosis: an underrecognized complication of short bowel syndrome. Gastroenterology Research and Practice 2015. Available on line at: Health demands that the pH of blood is maintained within a narrow range (7.35-7.45). Monitoring this physiological imperative and detection of so-called acid-base disturbance, in which blood pH is either increased or decreased, is one of the principal clinical utilities of blood gas analysis. Metabolic acidosis one of the four classes of acid-base disturbance identified by blood gas analysis is most commonly the result of abnormal accumulation of lactic acid, either due to increased metabolic production, reduced elimination or a combination of the two.This most common form of metabolic acidosis should, strictly speaking, be called L-lactic acidosis rather than simply lactic acidosis, as is usually the case. The nomenclature, L-lactic acidosis recognizes that in nature lactic acid can exist in two stereoisomeric forms: L-lactic acid and D-lactic acid. In humans (and indeed all mammals) lactic acid exists almost exclusively as the L-isoform, and it is accumulation of this isoform that accounts for almost all cases of lactic acidosis. A recently published article focuses on the very rare instance in which lactic acidosis is caused not by accumulation of L-lactic acid, but rather accumulation of D-lactic acid. The authors provide the detail of D-lactic acidosis under five headings: pathophysiology, clinical features, diagnosis and treatment. Central to an understanding of the pathophysiology of D-lactic acidosis is the recognition that many bacterial species normally present in the colon produce D-lactic acid. An overgrowth of the Continue reading >>

Approaches To D-lactic Acidosis

Approaches To D-lactic Acidosis

lassesen 10:12 pm on September 22, 2015 My last post cites a 2009 article that found: Faecal microbial flora of CFS patients and control subjects. The mean viable count of the total aerobic microbial flora for the CFS group (1.93108 cfu/g) was significantly higher than the control group (1.09108 cfu/g) (p<0.001). There was a significant predominance of Gram positive aerobic organisms in the faecal microbial flora of CFS patients. This study confirms the previous observation (22), and those reported by other investigators (23) that there was a marked alteration of faecal microbial flora in a sub-group of CFS patients.. In this study the mean total count for Enterococcus and Streptococcus spp. for the CFS group was 52% of the total aerobic intestinal flora, which is significantly higher than the 12% seen in the control subjects (p<0.01). largely old hat to readers of this blog, a microbiome dysfunction. But the study went on to some new interesting stuff, a possiblemechanism: In this study the NMR-based metabolic profiles of the three intestinal micro-organisms, E. faecalis., S. sanguinis. and E. coli showed that the Gram positive bacteria (Enterococcus and Streptococcus spp.) produce more lactic acid than the Gram negative E. coli. Not surprisingly, these Gram positive bacteria were shown to lower the ambient pH of their environment in vitro as compared to that of E. coli. This suggests that when Enterococcus and Streptococcus spp. colonization in the intestinal tract is increased, the heightened intestinal permeability caused by increased lactic acid production may facilitate higher absorption of D-lactic acid into the bloodstream, henceforth perpetuating the symptoms of D-lactic acidosis. Increased intestinal permeability is also associated with endotoxin release from Continue reading >>

A Stand-alone Synbiotic Treatment For The Prevention Of D-lactic Acidosis In Short Bowel Syndrome

A Stand-alone Synbiotic Treatment For The Prevention Of D-lactic Acidosis In Short Bowel Syndrome

A Stand-Alone Synbiotic Treatment for the Prevention of D-Lactic Acidosis in Short Bowel Syndrome Kazuhiro Takahashi , Hideo Terashima , Keisuke Kohno , and Nobuhiro Ohkohchi Organ Transplantation Gastroenterological and Hepatobiliary Surgery, Faculty of Medicine, Division of Clinical Medicine, Graduate School of the University of Tsukuba, Tsukuba, Japan Organ Transplantation Gastroenterological and Hepatobiliary Surgery, Faculty of Medicine, Division of Clinical Medicine, Graduate School of the University of Tsukuba, Tsukuba, Japan Organ Transplantation Gastroenterological and Hepatobiliary Surgery, Faculty of Medicine, Division of Clinical Medicine, Graduate School of the University of Tsukuba, Tsukuba, Japan Organ Transplantation Gastroenterological and Hepatobiliary Surgery, Faculty of Medicine, Division of Clinical Medicine, Graduate School of the University of Tsukuba, Tsukuba, Japan Organ Transplantation Gastroenterological and Hepatobiliary Surgery, Faculty of Medicine, Division of Clinical Medicine, Graduate School of the University of Tsukuba, Tsukuba, Japan Reprint requests: Hideo Terashima, MD, PhD, or Kazuhiro Takahashi, MD, Organ Transplantation Gastroenterological and Hepatobiliary Surgery, Faculty of Medicine, Division of Clinical Medicine, Graduate School of University of Tsukuba, 1-1-1, Tennoudai, Tsukuba-city, Ibaraki 305-8575, Japan. Tel. and Fax: +81 29 853 3221; E-mail: [email protected] or [email protected] Copyright 2013 by the International College of Surgeons This article has been cited by other articles in PMC. Synbiotics are combinations of probiotics and prebiotics that have recently been used in the context of various gastrointestinal diseases, including infectious enteritis, inflammatory bowel disease, and bowel obstruction. W Continue reading >>

Extreme And Life-threatening Case Of Recurrent D-lactate Encephalopathy | Nephrology Dialysis Transplantation | Oxford Academic

Extreme And Life-threatening Case Of Recurrent D-lactate Encephalopathy | Nephrology Dialysis Transplantation | Oxford Academic

D-lactic acidosis has been reported in patients after a variety of gastrointestinal surgeries, particularly jejunoileal bypass. An insufficient length of small intestine to metabolize ingested carbohydrates leads to an abnormal carbohydrate load in the colon. These carbohydrates are metabolized by colonic anaerobes (especially Lactobacillus species) into the dextrorotary isomer of lactate. Unlike its levorotary counterpart, D-lactate has neurotoxic effects and patients suffering from a significant D-lactate burden may suffer encephalopathic symptoms. These symptoms are usually mild and self-limiting in patients with normal renal function. We present here a case of D-lactic acidosis in a patient with end-stage renal disease who developed recurrent and life-threatening respiratory failure due to severe D-lactic acid encephalopathy. To our knowledge, no previously reported case has been sufficiently severe to necessitate endotracheal intubation and mechanical ventilation. An array of treatments including hemodialysis effected a prompt reversal of sensorium to baseline. We describe the potential treatments for D-lactic acidosis, which can be viewed as a paradigm of substrate, catalyst and pathologic product and review reports of their relative efficacy. encephalopathy , anaerobes , d-lactate , lactic acidosis Case presentation and initial laboratory data A 60-year-old male presented to the emergency department (ED) after being referred by his primary physician for ataxic gait and slurred speech. He had suffered several similar episodes over the course of 5 months. At baseline, he was fully lucid and ambulatory. Notably, 8 months before presentation he had been admitted for an intestinal volvulus that necessitated the removal of 419 cm [165 inches] of diffusely necrotic jej Continue reading >>

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