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Severe illness caused by the products of bacterial metabolism in a child with a short gut

✍ Scribed by E. Haan; G. Brown; A. Bankier; D. Mitchell; S. Hunt; J. Blakey; G. Barnes

Publisher: Springer
Year: 1985
Tongue: English
Weight: 265 KB
Volume: 144
Category: Article
ISSN: 0340-6997
DOI: 10.1007/bf00491929

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✦ Synopsis

An 8-year-old boy with a short gut had six episodes of metabolic acidosis and neurological dysfunction over a 1 month period. The neurological features consisted of a depressed conscious state, confusion, aggressive behaviour, slurred speech and ataxia. The organic acid profile of urine demonstrated increased amounts of lactic, 3-hydroxypropionic, 3-hydroxyisobutyric, 2-hydroxyisocaproic, phenyllactic, 4hydroxyphenylacetic and 4-hydroxyphenyllactic acids. Of the lactic acid 99% was D-lactic acid. The anaerobic gut flora consisted almost entirely of Lactobacilli in unusually large numbers. A course of vancomycin prevented further episodes. A urinary organic acid profile may be diagnostic when a person with a short gut develops metabolic acidosis or an unusual encephalopathy and bacterial metabolites should be considered in other patients with unusual combinations of organic acids in the urine.

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