lactic acidosis

• related: anion gap metabolic acidosis, ICU
• tags: #nephrology

Type B

D-Lactic acidosis presents with an increased anion gap metabolic acidosis and characteristic neurologic findings of intermittent confusion, slurred speech, and ataxia in patients with short-bowel syndrome. Accumulation of the D-isomer of lactate can occur in patients with short-bowel syndrome following jejunoileal bypass or small-bowel resection. In these patients, excess carbohydrates that reach the colon are metabolized to D-lactate. Laboratory studies show increased anion gap metabolic acidosis with normal plasma lactate levels, because the D-isomer is not measured by conventional laboratory assays for lactate. Diagnosis is confirmed by specifically measuring D-lactate. This patient's lack of short-bowel syndrome rules out this diagnosis.

Type B

• Decreased clearance: malignancy, liver dysfunction, drugs (linezolid, HAART, maybe metformin)
• Short bowel syndrome: D lactic acid
• In hospital we check L lactic acid
• Mammals make L
• D lactate: bacteria fermentation in bowels make D lactate