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Cited by 99Clinical Nutrition and GastroenterologyMetabolism and Genetic DisordersGut microbiota and health

d-lactate encephalopathy

Thurn, Joseph R., Pierpont, Gordon L., Ludvigsen, Carl W., Eckfeldt, John H.·1985·The American Journal of Medicine
DOI 10.1016/0002-9343(85)90522-4
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Abstract

Although D-lactate is not a product of human intermediary metabolism, absorption of D-lactate produced by abnormal intestinal bacteria can cause systemic acidosis in patients who have undergone gastrointestinal surgery, particularly jejunoileal bypass. In order to learn more about the prevalence of D-lactate encephalopathy, its occurrence in other disorders, and how well D-lactate concentration correlates with clinical symptoms, serum D-lactate levels were determined in several specific populations. D-lactate was undetectable (less than 0.5 mmol/liter) in 72 healthy volunteers and 57 obese persons. In 33 patients who had jejunoileal bypass, 16 reported symptoms consistent with D-lactate encephalopathy since surgery. Nine of these 16 had D-lactate levels greater than 0.5 mmol/liter (range 0.7 to 11.5 mmol/liter). Levels of D-lactate fluctuated over time, and in two patients, markedly elevated levels correlated with an encephalopathy accompanied by hyperchloremic metabolic acidosis and elevated anion gap. In 470 randomly chosen hospitalized patients, D-lactate level greater than 0.5 mmol/liter was found in 13 (2.8 percent), and 60 percent of these had a history of gastrointestinal surgery or disease. It is concluded that elevated serum D-lactate levels are relatively common in patients with jejunoileal bypass, and although more rare, occur in other gastrointestinal disorders as well. The symptoms of D-lactate encephalopathy are quite sensitive, but not necessarily specific for this disorder.

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Crossref · 10.1016/0002-9343(85)90522-4

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  • Bacterial enzymes may produce neurotoxic metabolites such as D-lactic acid and ammonia.

    “Bacterial enzymes may produce neurotoxic metabolites such as D-lactic acid and ammonia.”

    From The Gut Microbiome and the Brain (2014) · cites this paper as [60]

  • D-lactate is usually produced in excess when small bowel resection allows delivery of a high carbohydrate load to the colon.

    “A product of microbial fermentation of carbohydrate, D-lactate is usually produced in excess when small bowel resection allows delivery of a high carbohydrate load to the colon.”

    From The Gut Microbiome and the Brain (2014) · cites this paper as [60]

  • D-lactic acid and ammonia are the most studied encephalotoxic metabolites.

    “The most studied are D-lactic acid60 and ammonia.61”

    From The Gut Microbiome and the Brain (2014) · cites this paper as [60]

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Authors
Thurn, J. R., Pierpont, G. L., Ludvigsen, C. W., & Eckfeldt, J. H.
Affiliations
Minneapolis VA Health Care System (US)
Corresponding author
Pierpont, Gordon L.
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
1985-12
Volume
79
Issue
6
Pages
717-721
ISSN
0002-9343 (ISSN-L)
DOI
10.1016/0002-9343(85)90522-4
OpenAlex
W2080488727
Cited by
99
References
21
Citations by year
2026: 1 · 2025: 3 · 2023: 3 · 2021: 3 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 4 · 2016: 1 · 2015: 2 · 2014: 2 · 2013: 2 · 2012: 2
FWCI
2.90
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The American Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Keywords
D-lactate, jejunoileal bypass, metabolic acidosis, hyperchloremic metabolic acidosis, anion gap, gastrointestinal surgery, prevalence, hospitalized patients
MeSH terms
Acidosis, Adult, Brain Diseases, Female, Humans, Jejunoileal Bypass, Lactates, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Lactic Acid

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