Contaminated well water driving d-lactic acidosis in child with short bowel syndrome

d-Lactic acidosis is a rare type of lactic acidosis that typically presents in patients with short bowel syndrome (SBS). Clinical features include a high anion-gap metabolic acidosis and acute onset of neurological impairment. The underlying pathology is thought to be due to altered gut flora and carbohydrate malabsorption in patients with altered gut anatomy. The treatment centers on correcting acid-base derangements, dietary modifications to decrease carbohydrate intake and antibiotics. We present a case of recurrent d-lactic acidosis in a patient with SBS. In this unique case, we highlight the importance of considering the home environment when developing a treatment plan.