MORRIS TRAUBE, M.D.; JAY L. BOCK, M.D.; Ph.D.; JAMES L. BOYER, M.D.
A 40-year-old man with jejunoileal bypass developed a syndrome of bizarre behavior, slurred speech, ataxic gait, and inappropriate affect, associated with a metabolic acidosis characterized by an increase in the anion gap. Serum L-lactate level was normal, but high-resolution proton nuclear magnetic resonance spectrums of the patient's serum showed a high concentration of lactate. A diagnosis of D-lactic acidosis was confirmed by a specific enzymatic assay for D-lactate. The D-lactic acidosis was cleared using antibiotic therapy, suggesting that D-lactate is produced from fermentation of ingested carbohydrate by colonic bacteria. Nuclear magnetic resonance spectroscopy is a rapid screening test for identifying
MORRIS TRAUBE, JAY L. BOCK, JAMES L. BOYER. D-Lactic Acidosis After Jejunoileal Bypass: Identification of Organic Anions by Nuclear Magnetic Resonance Spectroscopy. Ann Intern Med. 1983;98:171–173. doi: 10.7326/0003-4819-98-2-171
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Published: Ann Intern Med. 1983;98(2):171-173.
Endocrine and Metabolism, Obesity.
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