sodium-bicarbonate and Short-Bowel-Syndrome

Topics: Acid-Base Equilibrium; Acidosis, Lactic; Anti-Bacterial Agents; Confusion; Diet, Carbohydrate-Restricted; Female; Fluid Therapy; Gait Ataxia; Humans; Memory, Short-Term; Mental Processes; Middle Aged; Risk Factors; Short Bowel Syndrome; Sodium Bicarbonate

Short bowel syndrome (SBS) is a condition when a person's gastrointestinal function is insufficient to supply the body with essential nutrients and hydration. Patients with SBS suffer from diarrhoea and symptoms of malabsorption such as weight loss, electrolyte disturbances and vitamin deficiencies. Long-term management of this condition can be complicated by the underlying disease, the abnormal bowel function and issues related to treatment like administration of parenteral nutrition and the use of a central venous catheter. Here, we describe a case of D-lactic acid acidosis, a rarer complication of SBS, presenting with generalised weakness and severe metabolic acidosis.

Topics: Acidosis, Lactic; Aged; Anti-Infective Agents; C-Reactive Protein; Humans; Lactic Acid; Male; Parenteral Nutrition, Home; Rifamycins; Rifaximin; Short Bowel Syndrome; Sodium Bicarbonate

d-lactic acidosis is a rare and severe complication of short bowel syndrome in children that may result from important ileal bacterial overgrowth by lactobacilli. Intestinal flora (Lactobacilli) is responsible for the production of d-lactic acid after fermentation of food carbohydrates.. We report on the case of a 6-year-old child with a short bowel syndrome treated with both home enteral and parenteral nutrition. The patient suddenly presented with acute neurological symptoms including dysarthria and disorientation. Biological analysis revealed metabolic acidosis, increased plasma d-lactic acid assessed by organic acid chromatography analysis and a very important increase in expired hydrogen during glucose breath test. Lactobacillus fermentum (known to produce d and L isomers of lactic acid) was isolated in the gastric liquid and rectal swabs. Clinical and biological evolution was rapidly favourable after treatment with intravenous sodium bicarbonate, antibiotic therapy and interruption of enteral nutrition.. d-lactic acidosis should be suspected when neurological symptoms occur in a child with short bowel syndrome. They can be prevented by treating intestinal bacterial overgrowth.

Topics: Acidosis, Lactic; Anti-Bacterial Agents; Child; Follow-Up Studies; Humans; Intestines; Lactic Acid; Lactobacillus; Male; Parenteral Nutrition; Short Bowel Syndrome; Sodium Bicarbonate; Time Factors; Treatment Outcome

Topics: Acidosis; Bacterial Infections; Bicarbonates; Breast Feeding; Catheters, Indwelling; Diarrhea, Infantile; Follow-Up Studies; Humans; Infant, Newborn; Intestinal Obstruction; Male; Metronidazole; Milk, Human; Neomycin; Parenteral Nutrition; Ranitidine; Short Bowel Syndrome; Sodium; Sodium Bicarbonate; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vomiting