We report the case of a 35-year-old woman followed up on an outpatient basis by the Nutrition Unit for 7 years due to a severe short bowel syndrome (SBS) with a remaining small intestine of 50 cm.
Among his personal history, he highlights a traffic accident suffered at 21 years old, intervening in fracture and traumatic intestinal perforation.
Since then, she had suffered several episodes compatible with intestinal subocclusion due to flanges, requiring hospitalization and resolved with conservative treatment.
At 28 years of age, an urgent laparotomy was performed due to an acute abdomen, finding an irreversible necrosis of the small intestine from the ileocecal valve to about 50 cm distal to the Treitz angle.
Given these findings, we proceeded to a massive resection of the small intestine including the cecal pole with jejunocolic thermal-terminal anastomosis.
Five years after surgery, the patient consulted for sporadic episodes of dizziness lasting about 5-6 hours with instability in gait and even with a fall to the ground, without loss of vision blurred and loss of consciousness.
In the following weeks, the frequency and duration of the episodes increased, occurring at least once a week and lasting up to 3-4 days to resolve.
In addition, symptoms were more pronounced, with irritability, general weakness, muscle aches and frequent liquid stools.
Although glycemia levels were confirmed to be normal during the episodes, the patient tried to solve the episodes by increasing the ingestion of quick absorption carbohydrates.
Neurological and otorhinolaryngological examination, electroencephalogram and brain magnetic resonance imaging were normal.
Metabolic acidosis with an elevated anion GAP: pH 7.3 (7.33-7.45), pCO2 24.2 mmHg (35-50), anion-121 (HCO3) was observed.
The rest of the biochemistry and serum lactate were normal.
Given the clinical and analytical data, the suspected diagnosis was a clinical picture of D-lactic acidosis secondary to an intestinal bacterial overgrowth of acid lactic bacteria, with a low-carbohydrate diet and a moderate fat restriction.
In case of persistent dizziness, oral metronidazole and bicarbonate were recommended.
The confirmation diagnosis was obtained by determining the plasmatic D-calcium normalizing during a 498-degree feedback episode to an external laboratory (Clinical Biochemistry Unit of Birminghan Pediatric Hospital, 19 μm).3,
Since she began to follow dietary advice, she has not had serious episodes anymore, being very occasional.
In recent years, it has achieved a complete nutritional rehabilitation, regardless of artificial nutrition.
The patient enjoys a normal life and has never required antibiotic treatment or bicarbonate or hospital admission.
