Metabolic acidosis due to d-lactate in a patient with intestinal resection: Diagnostic challenges and nutritional strategies.

Introduction: 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.

Presentation Of Case: 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.

Discussion: 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.

Conclusion: Early diagnosis of D-lactate acidosis enables effective management through carbohydrate restriction, reducing bacterial fermentation and improving clinical outcomes.