Patiño Leonardo Arzayus, Fuentes Claudia Martínez, Ochoa Olid Ivan, Estela-Zape Jose Luis
Faculty of Health, Universidad Santiago de Cali, Cali, Colombia.
Faculty of Health, Pontificia Universidad Javeriana, Cali, Colombia.
Int J Surg Case Rep. 2025 Jan;126:110801. doi: 10.1016/j.ijscr.2024.110801. Epub 2024 Dec 28.
Metabolic acidosis, marked by decreased plasma bicarbonate and arterial pH, is a common complication following extensive abdominal surgeries. D-lactate acidosis presents additional diagnostic challenges due to nonspecific symptoms.
A 65-year-old woman with hypertension and morbid obesity was admitted to the ICU for intestinal obstruction and peritonitis due to an incarcerated hernia. Extensive bowel resection required ileostomy and prolonged antibiotic therapy. She developed refractory metabolic acidosis, suspected to be D-lactate acidosis. Management included sodium bicarbonate for acid-base correction and carbohydrate restriction via enteral nutrition. Gradual carbohydrate reintroduction resolved the acidosis. After clinical stabilization, elevated D-lactate levels were confirmed, and she transitioned to an oral diet with protein supplementation.
Treatment focused on carbohydrate restriction to limit D-lactate production by reducing intestinal fermentation. Fructose was initially considered for its unique absorption properties that prevent fermentation, but limited formula availability led to complete carbohydrate elimination. Complex carbohydrates were gradually reintroduced to meet metabolic requirements without worsening acidosis. Intravenous bicarbonate, probiotics, and antibiotics were employed to manage severe acidosis. This case emphasizes the importance of individualized, multidisciplinary approaches in managing D-lactic acidosis and underscores the need for accessible, effective nutritional formulas.
Early diagnosis of D-lactate acidosis enables effective management through carbohydrate restriction, reducing bacterial fermentation and improving clinical outcomes.
代谢性酸中毒以血浆碳酸氢盐降低和动脉血pH值下降为特征，是腹部大手术后常见的并发症。由于症状不具特异性，D-乳酸酸中毒带来了额外的诊断挑战。
一名65岁患有高血压和病态肥胖的女性因嵌顿疝导致肠梗阻和腹膜炎入住重症监护病房。广泛的肠切除需要进行回肠造口术和长期抗生素治疗。她出现了难治性代谢性酸中毒，怀疑是D-乳酸酸中毒。治疗措施包括用碳酸氢钠纠正酸碱平衡以及通过肠内营养限制碳水化合物摄入。逐渐重新引入碳水化合物后酸中毒得到缓解。临床稳定后，确认了D-乳酸水平升高，随后她过渡到补充蛋白质的口服饮食。
治疗重点是限制碳水化合物摄入，通过减少肠道发酵来限制D-乳酸的产生。最初考虑使用果糖，因其独特的吸收特性可防止发酵，但由于配方供应有限，导致完全消除碳水化合物。逐渐重新引入复合碳水化合物以满足代谢需求，同时不加重酸中毒。静脉注射碳酸氢钠、益生菌和抗生素用于治疗严重酸中毒。该病例强调了个体化、多学科方法在管理D-乳酸酸中毒中的重要性，并突出了可获得有效营养配方的必要性。
早期诊断D-乳酸酸中毒可通过限制碳水化合物摄入进行有效管理，减少细菌发酵并改善临床结果。
