N. S. MANN, MD., F.R.C.P.(C); H. B. RUSSMAN, M.D.; S. K. MANN, M.D.; M. F. TSAI, M.D., M.P.H.
To the editor: In an excellent recent review on lactic acidosis (1), sorbitol has been listed as one cause. Advanced liver disease and end-stage renal disease are also known causes (2). Sorbitol, like lactulose, has been used in the management of hepatic encephalopathy (3) and lowers the stool pH. Lactulose given orally markedly lowers the colonic pH (4) because it reaches the colon unchanged and is acted on by colonic bacteria, which break it down into lactic, acetic, and formic acids. Acidic colonic contents trap ammonia, which is disposed of in the stools, facilitated by the additional laxative effect of
MANN NS, RUSSMAN HB, MANN SK, TSAI MF. Lactulose and Severe Lactic Acidosis. Ann Intern Med. ;103:637. doi: 10.7326/0003-4819-103-4-637_1
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Published: Ann Intern Med. 1985;103(4):637.
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