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D-lactic acidosis 23 years after jejuno-ileal bypass
R K Narula1, A El Shafei, D Ramaiah
1Department of Internal Medicine, Division of Nephrology, Saint Louis University School of Medicine, Saint Louis, MO, USA.
Summary
D-lactate accumulation, a rare complication of jejuno-ileal bypass surgery, can cause encephalopathy years later. This case highlights delayed D-lactic acidosis diagnosis and treatment with vancomycin.
Area of Science:
- Biochemistry
- Gastroenterology
- Neurology
Background:
- D-lactate accumulation is an uncommon complication following jejuno-ileal bypass surgery.
- The condition is often misdiagnosed due to deceptive serum chemistries, including a normal anion gap metabolic acidosis.
- Previous cases presented 5-10 years post-surgery, making delayed presentations unusual.
Observation:
- A patient presented with D-lactic acidosis and encephalopathy 23 years after jejuno-ileal bypass.
- Initial misdiagnosis as drug intoxication complicated the clinical picture.
- Symptoms were reproduced by a carbohydrate load, confirming D-lactic acidosis.
Findings:
- Serum and urine D-lactate levels significantly increased after a carbohydrate challenge.
- The patient exhibited neurological symptoms including confusion and memory loss.
- Oral vancomycin treatment led to sustained resolution of symptoms.
Implications:
- This case expands the known timeline for D-lactic acidosis presentation post-jejuno-ileal bypass.
- It underscores the importance of considering D-lactic acidosis in patients with unexplained metabolic acidosis and neurological symptoms, irrespective of the time elapsed since surgery.
- The successful treatment with vancomycin offers a potential therapeutic strategy for this rare condition.
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