Karton M, Rettmer R L, Lipkin E W
Department of Medicine, University of Washington, Seattle 98195.
JPEN J Parenter Enteral Nutr. 1987 Nov-Dec;11(6):586-9. doi: 10.1177/0148607187011006586.
D-Lactic acid can accumulate in blood in some patients with intestinal failure, leading to a clinical syndrome of severe acidosis and encephalopathy. The possible impact of parenteral nutrition on its clinical course has not been established. One patient with a severe short-bowel syndrome supported by long-term parenteral nutrition who suffered repeated episodes of ataxia and disorientation associated with elevated serum levels of D-lactate was studied. Results demonstrated no impact of glucose- vs lipid-based parenteral nutrition formulations on total acid production or serum D-lactic acid levels, increased serum D-lactate levels during administration of neomycin, but prompt resolution of both acidosis and clinical symptoms with discontinuation of oral intake. This study confirms the findings of other investigators that D-lactic acidosis may be a significant, heretofore unappreciated complication in patients with severe short-bowel syndrome, and that prompt resolution may be effected with abrupt discontinuation of oral intake. Furthermore, the present study suggests neither a detrimental nor a beneficial effect of parenteral nutrition on this syndrome.
在一些肠衰竭患者中，D - 乳酸可在血液中蓄积，导致严重酸中毒和脑病的临床综合征。肠外营养对其临床病程的可能影响尚未明确。对一名患有严重短肠综合征并长期接受肠外营养支持的患者进行了研究，该患者反复出现共济失调和定向障碍发作，同时血清D - 乳酸水平升高。结果表明，基于葡萄糖与基于脂质的肠外营养制剂对总酸生成或血清D - 乳酸水平均无影响，在使用新霉素期间血清D - 乳酸水平升高，但停止口服摄入后酸中毒和临床症状迅速缓解。本研究证实了其他研究者的发现，即D - 乳酸酸中毒可能是严重短肠综合征患者中一种重要的、迄今未被认识到的并发症，并且突然停止口服摄入可迅速缓解症状。此外，本研究表明肠外营养对该综合征既无有害影响也无有益影响。
