Dietary management ofD-lactic acidosis in short bowel syndrome

concentration.' Dahlquist et al were able to precipitate an episode of D-lactic acidosis in a patient with intestinal bypass surgery, by using a 25-08 MJ (6000 kcal) load containing 54% carbohydrate.5 Similarly, Rosenthal and Pesce described a recurrence of abnormal neurological signs, together with high D-lactate concentrations, in a patient in whom enteral feeds were substantially increased.6 Our studies show the importance of the nature of the dietary carbohydrate substrate in the production of D-lactic acidosis. Manipulation of dietary carbohyrate with strict control of monosaccharides and oligosaccharides was successful in our patient and preferable to repeated courses of broad spectrum antibiotics, which may alter the colonic flora in such a way as to impair valuable colonic salvage of nonabsorbed nutrients.