Uchida Hiroo, Yamamoto Hideki, Kisaki Yoshiyuki, Fujino Junko, Ishimaru Yuki, Ikeda Hitoshi
Department of Pediatric Surgery, Dokkyo University School of Medicine, Koshigaya Hospital, Koshigaya, Japan.
J Pediatr Surg. 2004 Apr;39(4):634-6. doi: 10.1016/j.jpedsurg.2003.12.026.
D-lactic acidosis sometimes occurs in malabsorbed patients with short-bowel syndrome and is characterized by recurrent episodes of encephalopathy and metabolic acidosis. The characteristic neurologic abnormalities and the presence of metabolic acidosis raises a diagnostic suspicion, and the diagnosis is made when the serum level of D-lactic acid is greater than 3 mmol/L. Standard treatment consists of restricting oral carbohydrates or fasting, correction of metabolic acidosis, and a long-term suppression of pathogenic floras with antibiotics. The authors present a case of D-lactic acidosis in a 22-year-old patient with short-bowel syndrome, to whom intestinal bacterial agents (probiotics) were given in addition to oral kanamycin. Recolonization of the intestine with nonpathogenic floras should be a long-term treatment for D-lactic acidosis.
D-乳酸酸中毒有时发生在短肠综合征吸收不良的患者中，其特征为反复出现的脑病和代谢性酸中毒发作。特征性的神经学异常和代谢性酸中毒的存在引发诊断怀疑，当血清D-乳酸水平大于3 mmol/L时可作出诊断。标准治疗包括限制口服碳水化合物或禁食、纠正代谢性酸中毒以及用抗生素长期抑制致病菌群。作者报告了一例22岁短肠综合征患者发生D-乳酸酸中毒的病例，该患者除口服卡那霉素外还给予了肠道细菌制剂（益生菌）。用非致病菌群使肠道重新定植应作为D-乳酸酸中毒的长期治疗方法。
