D-lactic acidosis in two patients with short bowel syndrome: bacteriological analyses of the fecal flora.

Two cases of D-lactic acidosis associated with short bowel syndrome are described. The administration of kanamycin to the patients showed a decrease in D-lactate in blood and urine in parallel with disappearance of metabolic acidosis. Bacteriological analyses of the fecal flora showed an increase in Lactobacillus buchneri in the first patient and Lactobacillus fermenti IVa in the second; both bacteria were sensitive to kanamycin. Quantification of in vitro production of D-lactate by each species of bacteria isolated from the feces revealed that Lactobacillus produced more D-lactate than other species of bacteria. These observations indicate that Lactobacillus may play an important role in the induction of D-lactic acidosis in patients with short bowel syndrome.