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A mild transient acidosis at the onset of his attacks and a history of bowel bypass five years earlier prompted metabolic screening. Markedly increased urinary <jats:sc>D<\/jats:sc>\u2010lactic and phenolic acids were present, as were intermittent elevations of plasma <jats:sc>D<\/jats:sc>\u2010lactic acid during two symptomatic episodes. Prompt and sustained clinical remission coincided with disappearance of abnormal organic acid excretion during oral antibiotic therapy. <jats:sc>D<\/jats:sc>\u2010Lactic acidosis must be considered in the differential diagnosis of otherwise unexplained neurological syndromes, particularly in patients with altered bowel anatomy.<\/jats:p>","DOI":"10.1002\/ana.410110216","type":"journal-article","created":{"date-parts":[[2005,1,1]],"date-time":"2005-01-01T13:29:58Z","timestamp":1104586198000},"page":"195-197","source":"Crossref","is-referenced-by-count":30,"title":["<scp>D<\/scp>\u2010lactic acidosis simulating a hypothalamic syndrome after bowel bypass"],"prefix":"10.1002","volume":"11","author":[{"given":"Daniel B.","family":"Carr","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivian E.","family":"Shih","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James M.","family":"Richter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph B.","family":"Martin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2004,10,7]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005053-197603000-00001"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/85.4.627"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.236.20.2298"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0009-8981(77)90297-2"},{"key":"e_1_2_1_6_2","first-page":"567","article-title":"Severe hyperchloremic acidosis complicating jejunoileal bypass","volume":"146","author":"Fuller TJ","year":"1978","journal-title":"Surg Gynecol Obstet"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.14.9.844"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005053-194704000-00001"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197908023010505"},{"key":"e_1_2_1_10_2","first-page":"415","volume-title":"The Hypothalamus","author":"Plum F","year":"1978"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/adc.55.10.810"},{"key":"e_1_2_1_12_2","first-page":"36A","article-title":"Evaluation and treatment of D\u2010lactate acidosis in two patients: a result of abnormal gut colonization","volume":"29","author":"Stolberg LM","year":"1981","journal-title":"Clin Res"},{"key":"e_1_2_1_13_2","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1093\/clinchem\/26.13.1847","article-title":"Gaschromatographic method of analysis for urinary organic acids. 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