Encephalopathy and high anion gap metabolic acidosis: an unusual herald of buried bumper syndrome

Acidification promotes overgrowth of acid-resistant bacteria, such as Lactobacillus spp, which produce D-lactate and further acidify the colon, creating a positive feedback loop.5 Systemic absorption of D-lactate can lead to encephalopathy and anion gap metabolic acidosis, hypothermia, and hypotensi...

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Bibliographic Details
Published in:The Lancet (British edition) 2015-02, Vol.385 (9969), p.744-744
Main Authors: Lopez, Eric Mark J, MD, Ghetmiri, Ehsan, MD, Gettle, Lori M, MD, Reed, Michael F, MD, McAllister, Brian P, Dr MD
Format: Article
Language:English
Subjects:
Acid-Base Equilibrium
Acidification
Acidosis - etiology
Antibiotics
Carbohydrates
Diagnosis, Differential
Flora
Humans
Hypotension - etiology
Hypothermia
Hypothermia - etiology
Internal Medicine
Lactic Acid - urine
Male
Metabolism
Metabolites
Middle Aged
Ostomy
Parenteral Nutrition - adverse effects
Parenteral Nutrition - methods
Postoperative Complications
Radiography, Abdominal
Treatment Outcome
Citations: Items that this one cites
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Summary:Acidification promotes overgrowth of acid-resistant bacteria, such as Lactobacillus spp, which produce D-lactate and further acidify the colon, creating a positive feedback loop.5 Systemic absorption of D-lactate can lead to encephalopathy and anion gap metabolic acidosis, hypothermia, and hypotension.4 Treatment consists of oral antibiotics targeting intestinal flora, a low carbohydrate diet, and occasionally bicarbonate and haemodialysis.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(15)60030-7