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D-lactic acidosis simulating a hypothalamic syndrome after bowel bypass

D B Carr, V E Shih, J M Richter

    Annals of Neurology
    |February 1, 1982
    PubMed
    Summary

    Episodic neurological symptoms were linked to D-lactic acidosis, a rare condition. Oral antibiotics resolved symptoms and normalized organic acid levels in a patient with a history of bowel bypass surgery.

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    Area of Science:

    • Neurology
    • Metabolic Disorders
    • Gastroenterology

    Background:

    • Episodic neurological symptoms can be challenging to diagnose.
    • Hypothalamic dysfunction can present with varied symptoms including hypersomnia and behavioral changes.
    • Altered bowel anatomy is a known risk factor for metabolic disturbances.

    Observation:

    • A 36-year-old man presented with a year of periodic symptoms including hypersomnia, thirst, irritability, and gorging behavior.
    • Initial neuroendocrine testing was normal, but transient acidosis and a history of bowel bypass prompted further investigation.
    • Metabolic screening revealed markedly increased urinary D-lactic and phenolic acids, with intermittent plasma D-lactic acid elevations during symptomatic episodes.

    Findings:

    • The patient was diagnosed with D-lactic acidosis.

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  • Treatment with oral antibiotics led to prompt and sustained clinical remission.
  • Abnormal organic acid excretion normalized with antibiotic therapy.

    • Implications:

    • D-Lactic acidosis should be considered in the differential diagnosis of unexplained neurological syndromes.
    • Patients with a history of bowel surgery or altered bowel anatomy are at increased risk.
    • This case highlights the importance of metabolic screening in patients with complex neurological presentations.