D-Lactic acidosis and encephalopathy after jejunoileostomy: response to overfeeding and to fasting in humans.

Two patients with recurring attacks of encephalopathy after jejunoileostomy for morbid obesity had elevated D-lactate concentrations in blood and urine. The syndrome and the biochemical abnormalities were reproduced by ingestion of a high carbohydrate diet. In the second case, fasting and intravenous supplementation with amino acids and glucose resulted in the disappearance of D-lactate from the urine and blood and amelioration of the symptoms. Stool cultures from the second patient were shown to be capable of producing D-lactate, and concentrations of D-lactate in saline and peptone yeast broth filtrates of the stool paralleled the changes in urinary excretion of the D-lactate during fasting and overfeeding. Thus, we have demonstrated a temporal relationship between the neurologic symptoms and the elevated concentrations of D-lactate in blood, urine, and stool. Whether D-lactate accounts for part or all of the encephalopathic changes remains to be determined.