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Patients with short bowel syndrome (SBS) are prone to periods of acute life-threatening metabolic acidosis attributable to the accumulation of d-lactate caused by bacterial overgrowth (1)(2)(3) The malabsorption of carbohydrates in the gut leads to large amounts of d- and l-lactate produced by intestinal flora (3). Because only l-lactate is routinely analyzed in most laboratories, an unrecognized d-lactic acidosis can have severe neurological consequences if not diagnosed and treated promptly.A 4-year-old boy with SBS after surgical correction for a small intestinal volvulus was admitted with a history of periodic metabolic acidosis. During a bout of fever, he developed a severe metabolic acidosis (pH 7.19; reference range, 7.35–7.45; P co …

Rapid Enantiomeric Differentiation of Urinary Metabolites in a Patient with Bacterial Overgrowth Syndrome