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Lactobacilli and acidosis in children with short small bowel

G Bongaerts1, J Bakkeren, R Severijnen

  • 1Department of Medical Microbiology, University Hospital Nijmegen Sint Radboud, Nijmegen, The Netherlands.

Journal of Pediatric Gastroenterology and Nutrition
|April 5, 2000
PubMed

Insights

In children with short small bowel, intestinal lactobacilli produce D-lactic acid, leading to metabolic acidosis. This study details the biochemical shifts and hyperventilation linked to D-lactic acidemia and aciduria in these patients.

Area of Science:

  • Pediatric Gastroenterology
  • Microbiology
  • Metabolic Disorders

Background:

  • Short small bowel in children can lead to D-lactic acidemia and D-lactic aciduria.
  • Intestinal lactobacilli are identified as the causative agents of these conditions.

Purpose of the Study:

  • To elucidate the metabolic acidosis in young children with short small bowel.
  • To detail the biochemical profile associated with D-lactic acid production.

Main Methods:

  • Microbiological and biochemical analysis of fecal, blood, and urine samples.
  • Study focused on children diagnosed with short small bowel and metabolic acidosis.

Main Results:

  • Lactobacilli comprised over 60% of fecal flora in patients without antibiotics.
  • D-lactic acid was the predominant metabolite in blood (serum D-lactate up to 15.5 mmol/l).
  • Peak urinary D-lactate excretion (59 mol/mol creatinine) occurred hours after hyperventilation; acidosis correlated with high D-lactate, anion gap, and low bicarbonate/pH.

Conclusions:

  • Intestinal lactobacilli in children with short small bowel produce significant D-lactic acid from carbohydrates.
  • This D-lactic acid directly alters bicarbonate, pH, and base excess.
  • The bacteria indirectly influence anion gap and trigger hyperventilation, with strong kinetic associations observed.
Abstract

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