Kang Kyung Pyo, Lee Sik, Kang Sung Kyew
Department of Internal Medicine, and Research Institute of Clinical Medicine, Chonbuk National University Medical School, Chonbuk, Korea.
Electrolyte Blood Press. 2006 Mar;4(1):53-6. doi: 10.5049/EBP.2006.4.1.53.
D-Lactic acidosis has been well documented in ruminants. In humans, D-lactic acidosis is very rare, but D-lactic acidosis may be more common than generally believed and should be looked for in a case of metabolic acidosis in which the cause of acidosis is not apparent. The clinical presentation of D-lactic acidosis is characterized by episodes of encephalopathy and metabolic acidosis. The entity should be considered as a diagnosis in a patient who presents with metabolic acidosis accompanied by high anion gap, normal lactate level, negative Acetest, history of short bowel syndrome or malabsorption, and characteristic neurologic manifestations. Low carbohydrate diet, bicarbonate treatment, rehydration, and oral antibiotics would be helpful in controlling symptoms.
D-乳酸酸中毒在反刍动物中已有充分记载。在人类中，D-乳酸酸中毒非常罕见，但可能比普遍认为的更为常见，在酸中毒病因不明的代谢性酸中毒病例中应予以排查。D-乳酸酸中毒的临床表现以脑病发作和代谢性酸中毒为特征。对于出现代谢性酸中毒伴高阴离子间隙、乳酸水平正常、Acetest阴性、有短肠综合征或吸收不良病史以及特征性神经表现的患者，应考虑该诊断。低碳水化合物饮食、碳酸氢盐治疗、补液和口服抗生素有助于控制症状。
