Short Bowel Syndrome and Acidosis

Introduction to Acidosis

Patients with short bowel syndrome, particularly those with a remaining colon, are at high risk of developing D-lactic acidosis 1, 2
The American Gastroenterological Association suggests that short bowel syndrome patients are prone to two types of acidosis: D-lactic acidosis, which is more common in patients with a remaining colon, and hyperammonemia-related acidosis, which can occur in both patients with a remaining colon and those with an ileostomy 1, 2, 3, 4

D-lactic acidosis is caused by the fermentation of excess carbohydrates, particularly simple sugars, by bacteria in the colon, resulting in the production of D-lactic acid, which is then absorbed and can lead to metabolic acidosis with an increased anion gap 1, 5
The European Society for Clinical Nutrition and Metabolism notes that the metabolism of D-lactic acid is difficult for the body, leading to its accumulation and the development of acidosis 1, 5

The clinical presentation of D-lactic acidosis includes symptoms such as confusion, altered mental status, and severe metabolic acidosis, with an increased anion gap and elevated serum D-lactate levels 1
The American College of Gastroenterology recommends that patients with short bowel syndrome and suspected D-lactic acidosis should undergo laboratory tests to measure serum D-lactate levels and assess the severity of acidosis 1, 3

The treatment of D-lactic acidosis involves dietary restrictions, such as limiting the intake of simple sugars and encouraging the consumption of complex carbohydrates, as well as the administration of thiamine supplements and broad-spectrum antibiotics 1, 3, 6
The European Society for Parenteral and Enteral Nutrition suggests that in severe cases, total parenteral nutrition may be necessary to manage D-lactic acidosis 1, 6

Patients with short bowel syndrome and a remaining colon are advised to follow a high-energy diet rich in complex carbohydrates, with normal amounts of fat and limited intake of simple sugars, to prevent the development of D-lactic acidosis 3, 6, 7
The American Society for Parenteral and Enteral Nutrition recommends that these patients should also avoid foods high in oxalate to reduce the risk of kidney stones 3, 6