Severe lactic acidosis reveals an allergy to cow milk.

The age of discovery and initial symptoms of cow milk allergy can vary. Lac tic acidosis is exceptionally associated to this allergy. Case report. - A 32-day-old girl war admitted for a severe;malaise with met abolic acidosis and hyperlactacidemia, There were no neonatal or family pro blems; breastfeeding was stopped on the 25th day. Fever was noted on the 29 th day and her mother reported behavior anomalies followed by a severe mala ise with unconsciousness between the 29th and 32nd day. At admission, the i nfant showed a severe neurological distress, hypotonia and lethargy. Infect ion and neurological imaging were normal A compensated metabolic acidosis w ith hyperlactacidemia (5.96 mmol/L) was noted. There was no argument for es ophageal reflux nor vagal hypertony; mitochondrial cytopathy was also exclu ded After a 24 hours fast, the clinical state gradually improved and normal ized at h48. The infant was discharged with a milk protein hydrolysate form ula. Her mother attempted to reintroduce cow milk on the 59th and 64th day, but this was immediately followed by allergic manifestations which support ed the diagnosis of cow cow milk allergy. Conclusion, - Neurological distress and hyperlactacidemia exceptionally rev eal this type of intolerance. The mechanism of hyperlactacidemia remains un clear; it is possibly the consequence of severe changes of the intestinal m ucosa, an exclusive glycolytic tissue. (C) 1999 Elsevier, Paris.