D-Lactic Acidosis After Jejunoileal Bypass: Identification of Organic Anions by Nuclear Magnetic Resonance Spectroscopy
Excerpt
A 40-year-old man with jejunoileal bypass developed a syndrome of bizarre behavior, slurred speech, ataxic gait, and inappropriate affect, associated with a metabolic acidosis characterized by an increase in the anion gap. Serum L-lactate level was normal, but high-resolution proton nuclear magnetic resonance spectrums of the patient's serum showed a high concentration of lactate. A diagnosis of D-lactic acidosis was confirmed by a specific enzymatic assay for D-lactate. The D-lactic acidosis was cleared using antibiotic therapy, suggesting that D-lactate is produced from fermentation of ingested carbohydrate by colonic bacteria. Nuclear magnetic resonance spectroscopy is a rapid screening test for identifying
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Acknowledgments
ACKNOWLEDGMENTS: Grant support: in part by grant CHE-791620 from the National Science Foundation to the Northeast Regional Nuclear Magnetic Resonance Facility.
Article and Author Information
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▸From the Departments of Internal Medicine and Laboratory Medicine, Yale University School of Medicine; New Haven, Connecticut.
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▸Requests for reprints should be addressed to Morris Traube, M.D.; Yale University School of Medicine, 92 LMP, 333 Cedar Street, P.O. Box 3333; New Haven, CT 06510.
- © 1983 American College of Physicians
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