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Colonic lactate metabolism andd-lactic acidosis

  • Intestinal Disorders, Inflammatory Bowel Disease, Immunology, And Microbiology
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Abstract

d-Lactic acidosis is seen in patients with intestinal bypass or short bowels in whom colonic producedd-lactate accumulates. An intestinal bypassed patient withd-lactic acidosis had higher fecald-lactate (122.4 mmol/liter) andl-lactate (90.1 mmol/liter) than described before in humans.d-Lactate fluctuated between 0.5 and 3.1 mmol/liter in plasma (normal<0.1 mmol/liter) and between 1.1 and 52.8 mmol/liter in urine (normal<0.7 mmol/liter) within a few hours, indicating that the human organism do metabolize and excreted-lactate. The patient withd-lactic acidosis had a 10-fold increasedDl-lactate production from glucose in fecal homogenates compared to 14 healthy controls and a patient with intestinal bypass, who did not haved-lactic acidosis. A 67% carbohydrate (starch)-enriched diet resulted in a minor elevation of fecal and plasma lactate, whereas 50 + 100+150 g of ingested lactose increasedd-lactate in feces (84.0 mmol/liter) and plasma (2.3 mmol/liter) considerably in the patient withd-lactic acidosis. Intestinal prolongation (22 cm ileum) had a temporary effect on fecal and plasmad-lactate, but intestinal continuity was reestablished 26 months later becaused-lactic acidosis recurred (plasma 8.6 mmol/liter, urine 101.3 mmol/liter). Large amounts of lactulose (160 g/day) to 12 normal individuals increasedd-lactate to 13.6±3.5 mmol/liter in feces, but never increasedd-lactate in plasma or urine. Thein vitro fermentation of glucose in fecal homogenates increasedDl-lactate, which disappeared after complete metabolization of the glucose.l-Lactate was converted tod-lactate andvice versa, and both were degraded to the short-chain fatty acids acetate, propionate, and butyrate. An infrequent, but elevated ability of the colonic flora to produce lactate may be a prerequisite ford-lactic acidosis to occur and may explain why the syndrome is so seldom seen even in patients with intestinal bypass or short bowels. The suggestion thatd-lactate is not metabolized and hence accumulates is probably not valid.

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Authors and Affiliations

  1. From the Department of Medicine A, Rigshospitalet, University of Copenhgen, Denmark

    Hanne Hove MD & Per Brøbech Mortensen MD, PhD

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  1. Hanne Hove MD
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  2. Per Brøbech Mortensen MD, PhD
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Hove, H., Mortensen, P.B. Colonic lactate metabolism andd-lactic acidosis. Digest Dis Sci 40, 320–330 (1995). https://doi.org/10.1007/BF02065417

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