D-Lactate-Associated Encephalopathy After Massive Small-Bowel Resection
D-Lactate-associated encephalopathy is a rare clinical syndrome characterized by dizziness, ataxia, confusion, headaches, memory loss, lethargy, and aggressiveness which may progress to frank but reversible coma. It occurs in patients with profound dysfunction of the short-bowel syndrome and is beli...
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| Veröffentlicht in: | Journal of clinical gastroenterology 1989-08, Vol.11 (4), p.448-451 |
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| container_end_page | 451 |
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| container_issue | 4 |
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| container_title | Journal of clinical gastroenterology |
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| creator | Scully, Thomas B Kraft, Sumner C Carr, William C Harig, James M |
| description | D-Lactate-associated encephalopathy is a rare clinical syndrome characterized by dizziness, ataxia, confusion, headaches, memory loss, lethargy, and aggressiveness which may progress to frank but reversible coma. It occurs in patients with profound dysfunction of the short-bowel syndrome and is believed to result from massive carbohydrate malabsorption with resultant overproduction of D-lactate and other organic anions by the colonic flora. Extremely elevated serum levels of D-lactate (but not L-lactate) confirm the diagnosis, but currently D-lactate is not clearly established as the putative neurotoxin. We describe a patient who repeatedly developed D-lactate encephalopathy after surgical removal of nearly the entire jejunum and ileum. Markedly elevated D-lactate serum levels were documented during an encephalopathic episode. Potential pathophysiologic mechanisms and the treatment rationale are discussed. |
| doi_str_mv | 10.1097/00004836-198908000-00020 |
| format | Article |
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It occurs in patients with profound dysfunction of the short-bowel syndrome and is believed to result from massive carbohydrate malabsorption with resultant overproduction of D-lactate and other organic anions by the colonic flora. Extremely elevated serum levels of D-lactate (but not L-lactate) confirm the diagnosis, but currently D-lactate is not clearly established as the putative neurotoxin. We describe a patient who repeatedly developed D-lactate encephalopathy after surgical removal of nearly the entire jejunum and ileum. Markedly elevated D-lactate serum levels were documented during an encephalopathic episode. Potential pathophysiologic mechanisms and the treatment rationale are discussed.</description><identifier>ISSN: 0192-0790</identifier><identifier>EISSN: 1539-2031</identifier><identifier>DOI: 10.1097/00004836-198908000-00020</identifier><identifier>PMID: 2760434</identifier><identifier>CODEN: JCGADC</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott-Raven Publishers</publisher><subject>Acidosis, Lactic - etiology ; Adolescent ; Biological and medical sciences ; Brain Diseases - etiology ; Gastroenterology. Liver. Pancreas. Abdomen ; Humans ; Ileum - surgery ; Intestinal Absorption ; Isomerism ; Jejunum - surgery ; Lactates - blood ; Lactic Acid ; Malabsorption Syndromes - complications ; Male ; Medical sciences ; Other diseases. Semiology ; Short Bowel Syndrome - complications ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</subject><ispartof>Journal of clinical gastroenterology, 1989-08, Vol.11 (4), p.448-451</ispartof><rights>Lippincott-Raven Publishers.</rights><rights>1989 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3840-5d485a51d1e2703facc4a07dbe17bcf48d9b2baff7163a4c526829cfd3198d723</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27929,27930</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=7296840$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/2760434$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Scully, Thomas B</creatorcontrib><creatorcontrib>Kraft, Sumner C</creatorcontrib><creatorcontrib>Carr, William C</creatorcontrib><creatorcontrib>Harig, James M</creatorcontrib><title>D-Lactate-Associated Encephalopathy After Massive Small-Bowel Resection</title><title>Journal of clinical gastroenterology</title><addtitle>J Clin Gastroenterol</addtitle><description>D-Lactate-associated encephalopathy is a rare clinical syndrome characterized by dizziness, ataxia, confusion, headaches, memory loss, lethargy, and aggressiveness which may progress to frank but reversible coma. It occurs in patients with profound dysfunction of the short-bowel syndrome and is believed to result from massive carbohydrate malabsorption with resultant overproduction of D-lactate and other organic anions by the colonic flora. Extremely elevated serum levels of D-lactate (but not L-lactate) confirm the diagnosis, but currently D-lactate is not clearly established as the putative neurotoxin. We describe a patient who repeatedly developed D-lactate encephalopathy after surgical removal of nearly the entire jejunum and ileum. Markedly elevated D-lactate serum levels were documented during an encephalopathic episode. Potential pathophysiologic mechanisms and the treatment rationale are discussed.</description><subject>Acidosis, Lactic - etiology</subject><subject>Adolescent</subject><subject>Biological and medical sciences</subject><subject>Brain Diseases - etiology</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Humans</subject><subject>Ileum - surgery</subject><subject>Intestinal Absorption</subject><subject>Isomerism</subject><subject>Jejunum - surgery</subject><subject>Lactates - blood</subject><subject>Lactic Acid</subject><subject>Malabsorption Syndromes - complications</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Other diseases. Semiology</subject><subject>Short Bowel Syndrome - complications</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</subject><issn>0192-0790</issn><issn>1539-2031</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1989</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kVtLAzEQhYMotVZ_grAPvkZz203yWGutQkXw8hxmswm7mnbLZmvpvzfa2jcHwiTMOQPnC0IZJdeUaHlDUgnFC0y10kSlF06HkSM0pDnXmBFOj9GQUM0wkZqcorMYPwihknM6QAMmCyK4GKLZHZ6D7aF3eBxja5t0q7Lp0rpVDaFdQV9vs7HvXZc9QYzNl8teFxACvm03LmQvLjrbN-3yHJ14CNFd7PsIvd9P3yYPeP48e5yM59hyJQjOK6FyyGlFHZOEe7BWAJFV6agsrReq0iUrwXtJCw7C5qxQTFtf8RS0koyPkNrttV0bY-e8WXXNArqtocT8oDF_aMwBjflFk6yXO-tqXS5cdTDuWaT51X4O0ULwHSxtEw8yyXSRIiSZ2Mk2bUhY4mdYb1xnagehr81_H8O_Ac2EetI</recordid><startdate>198908</startdate><enddate>198908</enddate><creator>Scully, Thomas B</creator><creator>Kraft, Sumner C</creator><creator>Carr, William C</creator><creator>Harig, James M</creator><general>Lippincott-Raven Publishers</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>198908</creationdate><title>D-Lactate-Associated Encephalopathy After Massive Small-Bowel Resection</title><author>Scully, Thomas B ; Kraft, Sumner C ; Carr, William C ; Harig, James M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3840-5d485a51d1e2703facc4a07dbe17bcf48d9b2baff7163a4c526829cfd3198d723</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1989</creationdate><topic>Acidosis, Lactic - etiology</topic><topic>Adolescent</topic><topic>Biological and medical sciences</topic><topic>Brain Diseases - etiology</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Humans</topic><topic>Ileum - surgery</topic><topic>Intestinal Absorption</topic><topic>Isomerism</topic><topic>Jejunum - surgery</topic><topic>Lactates - blood</topic><topic>Lactic Acid</topic><topic>Malabsorption Syndromes - complications</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Other diseases. Semiology</topic><topic>Short Bowel Syndrome - complications</topic><topic>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Scully, Thomas B</creatorcontrib><creatorcontrib>Kraft, Sumner C</creatorcontrib><creatorcontrib>Carr, William C</creatorcontrib><creatorcontrib>Harig, James M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Journal of clinical gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Scully, Thomas B</au><au>Kraft, Sumner C</au><au>Carr, William C</au><au>Harig, James M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>D-Lactate-Associated Encephalopathy After Massive Small-Bowel Resection</atitle><jtitle>Journal of clinical gastroenterology</jtitle><addtitle>J Clin Gastroenterol</addtitle><date>1989-08</date><risdate>1989</risdate><volume>11</volume><issue>4</issue><spage>448</spage><epage>451</epage><pages>448-451</pages><issn>0192-0790</issn><eissn>1539-2031</eissn><coden>JCGADC</coden><abstract>D-Lactate-associated encephalopathy is a rare clinical syndrome characterized by dizziness, ataxia, confusion, headaches, memory loss, lethargy, and aggressiveness which may progress to frank but reversible coma. It occurs in patients with profound dysfunction of the short-bowel syndrome and is believed to result from massive carbohydrate malabsorption with resultant overproduction of D-lactate and other organic anions by the colonic flora. Extremely elevated serum levels of D-lactate (but not L-lactate) confirm the diagnosis, but currently D-lactate is not clearly established as the putative neurotoxin. We describe a patient who repeatedly developed D-lactate encephalopathy after surgical removal of nearly the entire jejunum and ileum. Markedly elevated D-lactate serum levels were documented during an encephalopathic episode. Potential pathophysiologic mechanisms and the treatment rationale are discussed.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott-Raven Publishers</pub><pmid>2760434</pmid><doi>10.1097/00004836-198908000-00020</doi><tpages>4</tpages></addata></record> |
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| identifier | ISSN: 0192-0790 |
| ispartof | Journal of clinical gastroenterology, 1989-08, Vol.11 (4), p.448-451 |
| issn | 0192-0790 1539-2031 |
| language | eng |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Acidosis, Lactic - etiology Adolescent Biological and medical sciences Brain Diseases - etiology Gastroenterology. Liver. Pancreas. Abdomen Humans Ileum - surgery Intestinal Absorption Isomerism Jejunum - surgery Lactates - blood Lactic Acid Malabsorption Syndromes - complications Male Medical sciences Other diseases. Semiology Short Bowel Syndrome - complications Stomach. Duodenum. Small intestine. Colon. Rectum. Anus |
| title | D-Lactate-Associated Encephalopathy After Massive Small-Bowel Resection |
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