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Neurologic symptoms include altered mental status, slurred speech, and ataxia, with patients often appearing drunk. Onset of neurologic symptoms is accompanied by metabolic acidosis and elevation of plasma <jats:sc>d<\/jats:sc>\u2010lactate concentration. In these patients, malabsorbed carbohydrate is fermented by an abnormal bacterial flora in the colon, which produces excessive amounts of <jats:sc>d<\/jats:sc>\u2010lactate. High amounts of <jats:sc>d<\/jats:sc>\u2010lactate are absorbed into the circulation, resulting in an elevated concentration of <jats:sc>d<\/jats:sc>\u2010lactate in the blood. Development of neurologic symptoms has been attributed to <jats:sc>d<\/jats:sc>\u2010lactate, but it is unclear if this is the cause or whether other factors are responsible. This review examines the pathophysiology of the production and accumulation of <jats:sc>d<\/jats:sc>\u2010lactate while exploring the potential factors contributing to the development of neurologic manifestations. Methods of diagnosis and treatment are reviewed. Areas requiring further investigation are identified.<\/jats:p>","DOI":"10.1177\/0115426505020006634","type":"journal-article","created":{"date-parts":[[2008,5,14]],"date-time":"2008-05-14T19:23:41Z","timestamp":1210793021000},"page":"634-645","source":"Crossref","is-referenced-by-count":149,"title":["D\u2010Lactic Acidosis"],"prefix":"10.1002","volume":"20","author":[{"given":"Craig","family":"Petersen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2005,12]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197908023010505"},{"key":"e_1_2_10_3_2","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1111\/j.1749-6632.1965.tb47466.x","article-title":"D\u2010lactic acidosis of ruminants","author":"Dunlop RH","year":"1965","journal-title":"Ann N Y Acad 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