D-Lactate associated encephalopathy in short bowel syndrome: management with long-term non-absorbable oral...

We describe a child with short bowel syndrome consequent upon jejunal atresia who developed recurrent episodes of D-Lactate associated encephalopathy. Three species of lactobacillus were isolated from the stool, each sensitive to neomycin. Oral neomycin administration resulted in rapid relief of all symptoms. Cessation of the neomycin on two occasions led to recurrent encephalopathic episodes which quickly resolved with recommencement of treatment. We discuss the possible aetiologies of this encephalopathy syndrome and the therapeutic options.