Acidosis

[eve789]

So I have a working hypothesis which is that one of my primary problems is with acidosis. I've had numerous blood tests over the last year, each taken when I was *not* experiencing severe fatigue. These each show an anion gap of 7-9 (normal).

However, tests taken a year and a half apart, each in the middle of an episode of severe fatigue showed anion gap of 17 (Na: 144, CL 107, CO2 20) and 15 (Na: 141, CL: 103, C02: 23.4).

In addition, on a metametrix lab, I tested high for pyruvate, l-lactate, and d-lactate. Also, I notice that my symptoms progress as the day goes on and that they worsen after meals (especially the neuro symptoms).

Unfortunately, since the l-lactate and d-lactate are not standard tests and were done through an alternative practitioner, the MDs generally ignore those results. I've shown my PCP numerous research studies on CFS & acidosis, as well as on the neurotoxic effects of lactate. He replied that the sample sizes are small, and I wonder if it's just that he wasn't trained in this in school. (One of my ID doctors, when I brought it up to her, did not know the difference between l-lactate and d-lactate, and said she had never been taught it.)

Anyway, I'd love to get a "legit" in the eyes of the medical establishment lab to confirm the high l-lactate / d-lactate finding. I think one reason why my doctors are so reluctant to think: maybe it's acidosis? is because they expect to see it in ICU patients or people with shortened bowel syndrome.

Any tips on how I can convince my doctor to take this hypothesis seriously? Any idea on further testing I might request?

For folks who have dealt with this before, how did you treat it?

 

[Glynis Steele]

Hi eve789,

I believe a urine organic acid test would show up l-lactate. It the total lactate is higher than normal, this would indicate to test for d-lactate. This urine sample should be taken late afternoon, as d-lactate builds up during the day, after each carb containing meal and peaks after your last meal of the day.

I think you are right about the doctors not knowing about regular doc's not getting d-lactic, as usually this is diagnosed by GI's who see is it in short bowel patient's, and these patients are brought in with a sudden onset of neurological changes, such as severe lethargy, sometimes bordering on coma, staggering gait, the appearance of being drunk in the absence of alcohol, abusive aggressive behaviour etc. Bearing in mind the GI already knows the patient from prior gastro problems, too. And yes to the only seeing this in critical care patients, too.

It does not usually present in patient's with a complete bowel, and I think this is a huge barrier for testing, and the fact that most path labs cannot test for it, as they do not the assay available. The test is usually carried out in a hospital setting, I am not sure, but think the blood needs to be centrifuged within an hour of being taken.

As far as treatment goes, this again is undertaken by a GI, who would prescribe minimally absorbed abx, for the bacterial overgrowth that caused d-lactic acid. Different abx may be tried on the patients, as the host's gut bacteria are unique to that individual, so each will respond to the abx that works on their own bacteria. An IV of sodium bicarbonate is sometimes given to correct the acidosis (though sometimes the acidosis seems to be transient). Also in some cases a nil by mouth policy is put in place for a few days, and afterward's a low carb diet followed.

The only thing I can think of is to ask for a urine organic acid test, (sample taken late afternnon) and see what the l-lactate results are. If they are higher than expected, this would indicate that some of this lactate is d-lactate and a further specific test would be needed, though this should be done by a GI.

HTH.

Glynis x

 

[xks201]

I am not sure about D-lactate contributing to total lactate count. D-Lactate poisoning and overgrowth of lactic acid producing bacteria (which are in 99.99% of commercial available probiotics and are nothing but poison in my opinion) are serious problems that although many doctors are ignorant of ... the medical literature shows people completely incapacitated from d-lactate acidosis. And D-lactate acidosis does not always show up as an abnormal ion gap on your complete metabolic panel blood test. In fact it rarely does. I have a scientific explanation for this somewhere that I can look for later if you really need it.

But what I would do is take studies to your doctor that you can just search for in google or pubmed of d-lactate poisoning. There is a study showing high lactate levels in the brain of CFS patients as well. Several others have posted here that their stool culture showed abnormally high levels of lactic acid producing bacteria. Again, common probiotics and yogurt are the worst possible things you could be eating right now. I fixed this problem by taking a soil based organism probiotic and looking around for lactic acid utilizing bacteria. Noticed a HUGE difference. No more carbohydrate intolerance. Between that and adding low dose klonopin to cool down my overactive sympathetic nervous system, possibly a very low dose SSRI, and making sure I was getting enough salt with my florinef - I am functional.

I went to my GI doc and asked him about the test and they didn't even have the test available and this is a university doctor. So unless you are at the mayo clinic or something I highly doubt the doctor will even know how to treat it. lol Pretty sick but true. As far as actually treating it - antibiotics did not help - only soil based organisms which are bacteriocidal. PM me with more info if you want the probiotic name.