Biochemia Medica, Vol. 30 No. 1, 2020.
Ostalo
https://doi.org/10.11613/BM.2020.011001
High anion gap metabolic acidosis caused by D-lactate: mind the time of blood collection
Matthias Weemaes
; Clinical Department of Laboratory Medicine, UZ Leuven, Leuven, Belgium
Martin Hiele
; Clinical Department of Gastroenterology, UZ Leuven, Leuven, Belgium
Pieter Vermeersch
orcid.org/0000-0001-7076-061X
; Clinical Department of Laboratory Medicine, UZ Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
Sažetak
Introduction: D-lactic acidosis is an uncommon cause of high anion gap acidosis.
Materials and methods: A 35-year old woman was admitted to the emergency room with somnolence, drowsiness, dizziness, incoherent speech
and drunk appearance. Her past medical history included a Roux-en-Y bypass. Point-of-care venous blood analysis revealed a high anion gap acidosis.
Based on the clinical presentation, routine laboratory results and negative toxicology screening, D-lactate and 5-oxoprolinuria were considered
as the most likely causes of the high anion gap acidosis. Urine organic acid analysis revealed increased lactate, but no 5-oxoproline. Plasma D-lactate
was < 1.0 mmol/L and could not confirm D-lactic acidosis.
What happened: Further investigation revealed that the blood sample for D-lactate was drawn 12 hours after admission, which might explain the
false-negative result. Data regarding the half-life of D-lactate are, however, scarce. During a second admission, one month later, D-lactic acidosis
could be confirmed with an anion gap of 40.7 mmol/L and a D-lactate of 21.0 mmol/L measured in a sample collected at the time of admission.
Main lesson: The time of blood collection is of utmost importance to establish the diagnosis of D-lactic acidosis due to the fast clearance of D-lactate
in the human body
Ključne riječi
D-lactate; D-lactic acidosis; high anion gap acidosis; preanalytical phase; case report
Hrčak ID:
234152
URI
Datum izdavanja:
15.2.2020.
Posjeta: 810 *