Long-term monitoring of D-lactic acidosis in a child

Area of Science:

• Pediatric Gastroenterology
• Clinical Biochemistry
• Microbiology

Background:

• Small intestinal resection, particularly for midgut volvulus, can lead to malabsorption and altered gut microbiota.
• Altered gut bacteria can ferment carbohydrates, producing D-lactic acid, a stereoisomer of the more common L-lactic acid.
• Elevated D-lactic acid levels can overwhelm metabolic pathways, leading to D-lactic acidosis.

Observation:

• A case report details an 11-month monitoring period of a 2.5-year-old child with a history of extensive small intestinal resection.
• The child presented with metabolic acidosis, increased anion gap, ataxia, and lethargy.
• Diagnosis was confirmed by measuring elevated plasma D-lactate levels.

Findings:

• The study confirms D-lactic acidosis as a potential complication in pediatric patients with significant small bowel resection.
• Bacterial overgrowth and fermentation in the remaining intestine are the presumed sources of D-lactic acid.
• Antibiotic therapy targeting gut bacteria led to rapid resolution of the child's acidosis and neurological symptoms.

Implications:

• Metabolic acidosis with an increased anion gap in post-small intestinal resection patients warrants investigation for D-lactic acidosis.
• Early diagnosis and targeted antibiotic treatment are crucial for managing D-lactic acidosis.
• Prolonged and prospective monitoring of acidosis in this vulnerable pediatric population is recommended to prevent severe complications.