Elsevier

Brain and Development

Volume 32, Issue 8, September 2010, Pages 691-694
Brain and Development

Case report
A case of D-lactic acid encephalopathy associated with use of probiotics

https://doi.org/10.1016/j.braindev.2009.09.024Get rights and content

Abstract

A five year old girl was admitted to the hospital for evaluation of intermittent ataxia. She had undergone serial resections of the small intestine after birth, resulting in short bowel syndrome. Lactomin was prescribed for watery diarrhea at twice the regular dose 2 weeks before the onset of neurologic symptoms. D-lactic acidosis was diagnosed on the basis of a plasma D-lactate level of 5.537 mmol/l. Lactomin was discontinued, and she was treated with sodium bicarbonate and oral antibiotics. The probiotics the patient had taken were likely the cause of D-lactic acidosis and should therefore be avoided in patients with short bowel syndrome.

Introduction

D-lactic acid is not produced in detectable levels in healthy people. D-lactic acidosis was first described in patients with short bowel syndrome by Oh et al. in 1979. D-lactic acidosis presents with various neurologic abnormalities, such as altered mental status, ataxia, and gait disturbances [1]. We report herein a case in which D-lactic acid-producing bacteria were suspected to be the cause of D-lactic acidosis.

Section snippets

Case report

A five year old girl was admitted to the hospital for evaluation of ataxia. She underwent resection of the small intestine on the day following birth for jejunoileal atresia. She subsequently had an extensive resection because of ileus and peritonitis. When she was discharged from the hospital at 9 months of age, the length of the residual small intestine was 45 cm and the ileocecal valve had been extirpated. Total parental nutrition had been given until 3 years of age, after which she began

Discussion

D-lactic acid is an optic isomer of L-lactic acid. Lactic acid is metabolized to pyruvate by the isomer-specific enzyme, lactic dehydrogenase. Humans have only L-LDH. D-lactic acidosis is observed in patients with intestinal failure, such as short bowel syndrome. No case has been reported in an individual with an intact digestive tract. Carbohydrate malabsorption in the small intestine leads to decreasing pH in the colon and subsequent overgrowth of D-lactic acid-producing bacteria. Acidosis is

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