Why is D-lactic acidosis more likely in a patient with an intact colon and short bowel?

Why is D-lactic acidosis more likely in a patient with an intact colon and short bowel?

• A. The colon harbors bacteria that ferment malabsorbed carbohydrates to D-lactic acid.
• B. The colon produces D-lactic acid directly into the bloodstream.
• C. D-lactic acid is produced in the small intestine and does not involve the colon.
• D. D-lactic acid is a normal metabolite in adults and not clinically significant.

Answer: (A)

D-lactic acidosis occurs when colonic bacteria ferment unabsorbed carbohydrates into D-lactic acid. An intact colon provides the bacterial population needed for this fermentation, and short bowel syndrome increases delivery of fermentable carbohydrates to the colon due to malabsorption and rapid transit. The D-lactate produced is absorbed but is not efficiently metabolized by humans, so it accumulates, causing metabolic acidosis (and often neurologic symptoms). This is why having a colon plus short bowel makes D-lactic acidosis more likely.

D-lactic acidosis occurs when colonic bacteria ferment unabsorbed carbohydrates into D-lactic acid. An intact colon provides the bacterial population needed for this fermentation, and short bowel syndrome increases delivery of fermentable carbohydrates to the colon due to malabsorption and rapid transit. The D-lactate produced is absorbed but is not efficiently metabolized by humans, so it accumulates, causing metabolic acidosis (and often neurologic symptoms). This is why having a colon plus short bowel makes D-lactic acidosis more likely.