D-lactic acidosis is a form of lactic acidosis caused by the accumulation of the D-isomer of lactate rather than the L-isomer produced as part of human metabolism. It occurs when carbohydrate in the gut is metabolized by an abnormal colonic bacterial flora. There is generation of D-lactate which is absorbed and causes a metabolic acidosis with encephalopathy.


Criteria for D-lactic acidosis:

(1) presence of short bowel syndrome or other form of malabsorption with an intact colon

(2) an acute episode of encephalopathic symptoms, such as confusion, slurred speech, ataxia, unsteady gait, abusive behavior and/or nystagmus

(3) metabolic acidosis with an increased anion gap

(4) normal L-lactate serum levels

(5) serum D-lactate levels > 3 mmol/L

(6) abnormal colonic flora, with a predominance of Gram-positive anaerobic bacteria, possibly following recent antibiotic therapy


The abnormal Gram-positive anaerobic flora may be composed of Lactobacilli, which produce large amounts of lactic acid.


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