Why should D-lactic acidosis be suspected in a patient with short bowel syndrome who has an intact colon?

Why should D-lactic acidosis be suspected in a patient with short bowel syndrome who has an intact colon?

• A. D-lactic acid is produced by the fermentation of malabsorbed carbohydrate in the colon.
• B. D-lactic acid is produced in the stomach by gastric bacteria.
• C. Humans readily metabolize D-lactic acid via hepatic enzymes.
• D. D-lactic acid is not produced in the human gut.

Answer: (A)

The main idea is that D-lactic acidosis happens when colonic bacteria ferment undigested carbohydrates that reach the colon, producing D-lactic acid that gets absorbed and isn’t cleared efficiently by the body. In short bowel syndrome with an intact colon, a lot of malabsorbed carbohydrate reaches the colon, where bacteria convert it into D-lactic acid. Humans don’t metabolize D-lactate as readily as L-lactate, so it can accumulate and lead to metabolic acidosis and neurologic symptoms, which is why D-lactic acidosis should be suspected in this scenario. The other statements aren’t the best fit because the stomach isn’t the primary site for D-lactic acid production, hepatic enzymes don’t effectively eliminate D-lactate, and D-lactic acid is indeed produced in the gut by bacteria rather than not being produced at all.

The main idea is that D-lactic acidosis happens when colonic bacteria ferment undigested carbohydrates that reach the colon, producing D-lactic acid that gets absorbed and isn’t cleared efficiently by the body. In short bowel syndrome with an intact colon, a lot of malabsorbed carbohydrate reaches the colon, where bacteria convert it into D-lactic acid. Humans don’t metabolize D-lactate as readily as L-lactate, so it can accumulate and lead to metabolic acidosis and neurologic symptoms, which is why D-lactic acidosis should be suspected in this scenario.

The other statements aren’t the best fit because the stomach isn’t the primary site for D-lactic acid production, hepatic enzymes don’t effectively eliminate D-lactate, and D-lactic acid is indeed produced in the gut by bacteria rather than not being produced at all.