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Antibiotic-Induced D-Lactic Acidosis

Boris E. Coronado, MD; Steven M. Opal, MD; and David C. Yoburn, MD
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From Brown University, Providence, and Memorial Hospital of Rhode Island, Pawtucket, Rhode Island. Acknowledgments: The authors thank Lisa Raymond, MS, RD, and Mildred Smith from Food and Nutrition Services and Roland Tremblay Jr. from Clinical Laboratory Referrals, Memorial Hospital of Rhode Island, for their technical support.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;122(11):839-842. doi:10.7326/0003-4819-122-11-199506010-00005
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Objective: To describe a case of oral antibiotic-induced D-lactic acidosis in a patient with enteric overgrowth of Lactobacillus acidophilus.

Design: Single case study.

Setting: University-affiliated community hospital.

Intervention: Oral carbohydrate challenge test with 4000 kcal/d.

Main Results: A patient had several episodes of D-lactic acidosis after receiving oral antibiotics. Stool cultures yielded Lactobacillus acidophilus resistant to the implicated agents. Provocative challenge with dietary carbohydrate alone, in the absence of antibiotics, failed to reproduce the syndrome.

Conclusions: Oral antibiotics may induce D-lactic acidosis in patients with the short-bowel syndrome by promoting the overgrowth of resistant D-lactate-producing organisms. Interactions between carbohydrate intake and antibiotic use are likely determinants in the development of this syndrome. Periodic use of stool cultures with antimicrobial susceptibility testing may assist in the management of these patients by optimizing the selection of antimicrobial agents.


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Figure 1.
D-Lactate levels after the intake of oral carbohydrates was increased.D

The patient had the short-bowel syndrome and received a challenge diet of 4000 kcal/d (64% carbohydrates, 17% protein, and 17% fat). Normal plasma and urine -lactate levels are 0 to 0.25 mmol/L.

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