D-lactic acidosis in humans: systematic literature review

Davide G.A.M. Bianchetti, Giacomo S. Amelio, Sebastiano A.G. Lava, Mario G. Bianchetti, Giacomo D. Simonetti, Carlo Agostoni, Emilio F. Fossali, Gregorio P. Milani

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: D-lactic acidosis is an uncommon and challenging form of metabolic acidosis that may develop in short bowel syndrome. It has been documented exclusively in case reports and small case series. Methods: We performed a review of the literature in the National Library of Medicine and Excerpta Medica databases. Results: We identified 84 original reports published between 1977 and 2017. D-lactic acidosis was observed in 98 individuals ranging in age from 7 months to 86 years with short bowel syndrome. The clinical presentation included Kussmaul breathing, confusion, slurred speech, and gait disturbances. Furthermore, among 99 consecutive patients with short bowel syndrome, 21 reported having episodes with symptoms consistent with D-lactic acidosis. In addition, D-lactic acid might also contribute to acidosis in diabetes mellitus. Finally, abnormally high D-lactic acid was documented after administration or ingestion of large amounts of propylene glycol, as paraneoplastic phenomenon and perhaps also in a so far poorly characterized inherited inborn error of metabolism. Conclusions: In humans with short bowel syndrome (or carbohydrate malabsorption), D-lactic acidosis is likely rather common and under-recognized. This condition should be included in the differential diagnosis of unexplained high-gap metabolic acidosis where the anion causing the acidosis is not known. Furthermore, diabetic acidosis might be caused by accumulation of both ketone bodies and D-lactic acid. Finally, there are endogenous sources of D-lactic acid in subjects with propylene glycol intoxication.

Original languageEnglish
Pages (from-to)673-681
Number of pages9
JournalPediatric Nephrology
Volume33
Issue number4
DOIs
Publication statusPublished - 2018

Fingerprint

Short Bowel Syndrome
Lactic Acidosis
Acidosis
Lactic Acid
Propylene Glycol
National Library of Medicine (U.S.)
Inborn Errors Metabolism
Ketone Bodies
Confusion
Diabetic Ketoacidosis
Gait
Anions
Diabetes Mellitus
Respiration
Differential Diagnosis
Eating
Carbohydrates
Databases

Keywords

  • Carbohydrate malabsorption
  • Diabetes mellitus
  • Propylene glycol
  • Short bowel syndrome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

Cite this

Bianchetti, D. G. A. M., Amelio, G. S., Lava, S. A. G., Bianchetti, M. G., Simonetti, G. D., Agostoni, C., ... Milani, G. P. (2018). D-lactic acidosis in humans: systematic literature review. Pediatric Nephrology, 33(4), 673-681. https://doi.org/10.1007/s00467-017-3844-8

D-lactic acidosis in humans : systematic literature review. / Bianchetti, Davide G.A.M.; Amelio, Giacomo S.; Lava, Sebastiano A.G.; Bianchetti, Mario G.; Simonetti, Giacomo D.; Agostoni, Carlo; Fossali, Emilio F.; Milani, Gregorio P.

In: Pediatric Nephrology, Vol. 33, No. 4, 2018, p. 673-681.

Research output: Contribution to journalArticle

Bianchetti, DGAM, Amelio, GS, Lava, SAG, Bianchetti, MG, Simonetti, GD, Agostoni, C, Fossali, EF & Milani, GP 2018, 'D-lactic acidosis in humans: systematic literature review', Pediatric Nephrology, vol. 33, no. 4, pp. 673-681. https://doi.org/10.1007/s00467-017-3844-8
Bianchetti DGAM, Amelio GS, Lava SAG, Bianchetti MG, Simonetti GD, Agostoni C et al. D-lactic acidosis in humans: systematic literature review. Pediatric Nephrology. 2018;33(4):673-681. https://doi.org/10.1007/s00467-017-3844-8
Bianchetti, Davide G.A.M. ; Amelio, Giacomo S. ; Lava, Sebastiano A.G. ; Bianchetti, Mario G. ; Simonetti, Giacomo D. ; Agostoni, Carlo ; Fossali, Emilio F. ; Milani, Gregorio P. / D-lactic acidosis in humans : systematic literature review. In: Pediatric Nephrology. 2018 ; Vol. 33, No. 4. pp. 673-681.
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