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D ‐lactic acidosis simulating a hypothalamic syndrome after bowel bypass
Author(s) -
Carr Daniel B.,
Shih Vivian E.,
Richter James M.,
Martin Joseph B.
Publication year - 1982
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410110216
Subject(s) - irritability , lactic acidosis , medicine , pallor , metabolic acidosis , acidosis , gastroenterology , anesthesia , endocrinology , menopause
Abstract A 36‐year‐old man had one year of periodic symptoms suggestive of episodic hypothalamic dysfunction: hypersomnia, thirst, ravenous hunger and gorging behavior, pallor, and irritability. However, neuroendocrine testing proved normal. A mild transient acidosis at the onset of his attacks and a history of bowel bypass five years earlier prompted metabolic screening. Markedly increased urinary D ‐lactic and phenolic acids were present, as were intermittent elevations of plasma D ‐lactic acid during two symptomatic episodes. Prompt and sustained clinical remission coincided with disappearance of abnormal organic acid excretion during oral antibiotic therapy. D ‐Lactic acidosis must be considered in the differential diagnosis of otherwise unexplained neurological syndromes, particularly in patients with altered bowel anatomy.