Lactobacilli and acidosis in children with short small bowel

Background: In patients with a short small bowel, D-lactic acidemia and D-l actic aciduria are caused by intestinal lactobacilli. The purpose of this s tudy was to obtain a detailed picture of the metabolic acidosis in young ch ildren with short small bowel. Methods: Feces, blood, and urine of children with short small bowel and aci dosis were studied microbiologically and/or biochemically. Results: Previous findings were confirmed that more than 60% of the fecal f lora of patients with small short bowel, who are not receiving antibiotics, consists of lactic acid-producing lactobacilli. In blood, D-lactic acid wa s the most prominent metabolite: the highest serum D-lactate (15.5 mmol/l) was observed in a sample taken immediately after the onset of hyperventilat ion. The highest D-lactate excretion was in urine collected some hours afte r the onset of hyperventilation, and amounted to 59 mol/mol creatinine. Aci dosis in the patients with short small bowel was related to strongly increa sed serum D-lactate and anion gap and to strongly decreased serum bicarbona te and pH. Conclusion: In children with small short bowel and acidosis, the common int estinal flora of mainly lactobacilli abundantly produces D-lactic acid from easily fermentable carbohydrates. Thus, these bacteria directly cause shif ts of bicarbonate, pH, and base excess and indirectly cause shifts of the a nion gap, as well as hyperventilation. These kinetic parameters are strongl y associated. (C) 2000 Lippincott Williams & Wilkins, Inc.