Dietary management of D-lactic acidosis in short bowel syndrome

Article Abstract:

Short bowel syndrome can be caused by a congenital disorder or by surgical removal of a section of the intestines. Patients with short bowel syndrome may have difficulty digesting certain carbohydrates. The non-absorbed carbohydrates are fermented by one type of normal intestinal bacteria called lactobacilli, producing D-lactic acid. Since the D-lactic acid cannot be metabolized, it is absorbed by the body to cause severe metabolic acidosis (acidic blood). Administration of antibiotics or oral administration of bacteria flora are two types of treatment. The experience of an nine-year-old girl with D-lactic acidosis who was treated with an altered carbohydrate diet is reported. The patient had previous intestinal resection in which 14 centimeters of her intestines were removed. She was maintained on parenteral nutrition for nine months, and then released with a normal diet and energy supplements. Six months later, after she ingested a large amount of sugar, signs of acidosis developed, such as uncoordinated movements, slurred speech and confusion. Similar episodes of metabolic acidosis occurred every time she ingested large amounts of sugar. The number of episodes were increasing, and growth failure was noted. In an effort to identify which carbohydrates produced acid, two strains lactobacilli isolated from the patient's stool were evaluated. It was discovered that the lactobacilli in the patient's intestines was unable to make D-lactate, essential for the metabolism of D-lactic acid. Therefore, the patient's diet could be altered to eliminate the offending carbohydrates. The altered diet, which included carbohydrates that were mainly in the polymeric form (mono and oligosaccharides), were given through a tube inserted into the nose and feed directly into the stomach. There have been no further acidotic episodes in the 30-month period that followed. The child continues to grow normally. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Malabsorption syndromes, Diet therapy, Lactic acidosis

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Pulmonary intravascular lipid in neonatal necropsy specimens

Article Abstract:

Parenteral nutrition, in which intravenous solutions of nutrients are given to replace or supplement eating, is an essential part of treatment for certain sick newborns, particularly those with respiratory distress or gastrointestinal disorders. Fats are an essential part of the diet, efficiently providing energy as well as compounds necessary for tissue growth. However, blockage of pulmonary (lung) capillaries (very small blood vessels) with fat has been found in infants given parenteral nutrition who subsequently died. Some researchers believe that this is a post-mortem (occurring after death) artifact. The relationship between pulmonary intravascular fat and parenteral feeding was evaluated in 41 parenterally-fed infants and 441 infants not fed by parenteral methods, all of whom subsequently died. Pulmonary lipid (fat) deposits in vessels were found in half of 30 infants fed parenteral supplements containing fat but not in the 11 infants given parenteral mixtures containing glucose and amino acids (building blocks of proteins) alone. No infants who did not receive parenteral feeding had intravascular fat. One infant had fat deposits in the vessels of many organs. Four patients with pulmonary vessel lipid had not received parenteral lipid for three to eight days before death. Heparin, which can affect the blood levels of enzymes which metabolize lipids, was given in a standard manner to all patients. The study suggests that although lipid particles may be a common consequence of parenteral lipid feeding, they probably have little medical relevance; thus parenteral lipid feeding should not be discontinued in preterm infants who cannot be fed by way of the digestive tract. It is, however, suggested that intravenous lipid be used with caution in babies at risk for increased resistance within the pulmonary vessels. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Complications and side effects, Physiological aspects, Food and nutrition, Parenteral feeding, Parenteral nutrition, Infants (Newborn), Newborn infants

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