Clinical Department of Laboratory Medicine, UZ Leuven, Leuven, Belgium.
Clinical Department of Gastroenterology, UZ Leuven, Leuven, Belgium.
Biochem Med (Zagreb). 2020 Feb 15;30(1):011001. doi: 10.11613/BM.2020.011001. Epub 2019 Dec 15.
D-lactic acidosis is an uncommon cause of high anion gap acidosis.
A 35-year old woman was admitted to the emergency room with somnolence, drowsiness, dizziness, incoherent speech and drunk appearance. Her past medical history included a Roux-en-Y bypass. Point-of-care venous blood analysis revealed a high anion gap acidosis. Based on the clinical presentation, routine laboratory results and negative toxicology screening, D-lactate and 5-oxoprolinuria were considered as the most likely causes of the high anion gap acidosis. Urine organic acid analysis revealed increased lactate, but no 5-oxoproline. Plasma D-lactate was < 1.0 mmol/L and could not confirm D-lactic acidosis.
Further investigation revealed that the blood sample for D-lactate was drawn 12 hours after admission, which might explain the false-negative result. Data regarding the half-life of D-lactate are, however, scarce. During a second admission, one month later, D-lactic acidosis could be confirmed with an anion gap of 40.7 mmol/L and a D-lactate of 21.0 mmol/L measured in a sample collected at the time of admission.
The time of blood collection is of utmost importance to establish the diagnosis of D-lactic acidosis due to the fast clearance of D-lactate in the human body.
D-乳酸酸中毒是一种罕见的高阴离子间隙酸中毒的原因。
一名 35 岁女性因嗜睡、昏睡、头晕、言语不清和醉酒样表现而被收入急诊室。她的既往病史包括 Roux-en-Y 旁路术。床边静脉血分析显示高阴离子间隙酸中毒。基于临床表现、常规实验室结果和阴性毒理学筛查，D-乳酸和 5-氧脯氨酸尿症被认为是高阴离子间隙酸中毒的最可能原因。尿有机酸分析显示乳酸增加，但 5-氧脯氨酸正常。血浆 D-乳酸<1.0mmol/L，无法确诊 D-乳酸酸中毒。
进一步的调查显示，D-乳酸的血样是在入院后 12 小时采集的，这可能解释了假阴性的结果。然而，关于 D-乳酸半衰期的数据却很有限。在一个月后的第二次入院时，入院时采集的样本中阴离子间隙为 40.7mmol/L，D-乳酸为 21.0mmol/L，可确诊 D-乳酸酸中毒。
由于 D-乳酸在人体内清除迅速，因此采集血样的时间对于确诊 D-乳酸酸中毒至关重要。
