Factors associated with D-lactic acidosis in pediatric intestinal failure: A case-control study

Area of Science:

• Pediatric Gastroenterology
• Metabolic Disorders
• Intestinal Failure Management

Background:

• D-lactic acidosis (DLA) is a severe complication in pediatric patients with intestinal failure (IF) due to short bowel syndrome (SBS).
• Bacterial metabolism of malabsorbed carbohydrates in the intestine produces D-lactate, potentially causing metabolic acidosis and neurological symptoms.

Purpose of the Study:

• To identify risk factors and clinical characteristics associated with D-lactic acidosis in children with short bowel syndrome.
• To improve the monitoring and diagnosis of DLA in pediatric patients with IF.

Main Methods:

• Retrospective chart review of children (≤18 years) with SBS.
• Inclusion criteria included unexplained metabolic acidosis, neurological symptoms, or suspected DLA.
• Cases defined by serum D-lactate >0.25 mmol/L; controls ≤0.25 mmol/L.

Main Results:

• Forty-six children (23 cases, 23 controls) were analyzed; median age 3.16 years, median residual bowel length 40 cm.
• Cases showed significantly lower bicarbonate and higher anion gap compared to controls.
• Multivariable analysis identified midgut volvulus (aOR=17.1), history of intestinal lengthening, and anion gap as independent risk factors for DLA.

Conclusions:

• DLA is a significant complication in pediatric IF patients with SBS.
• Close monitoring for DLA is crucial in IF patients with a history of midgut volvulus, intestinal lengthening procedures, or anion gap acidosis.