Acidemia in Short Bowel Syndrome

53 yM with hx of Protein C Deficiency (on LMWH), remote hx of mesenteric thrombosis and bowel resection (’81) admitted for severe mixed anion gap and non-anion gap acidosis (bicarb of 7 and ΔΔ <1).

Teaching points:

– estimate AG using albumin even though the measured AG appears normal- there may be an inapparent AG

– calculate ΔΔ (if there is an AG and low bicarb)=  ΔAG (calculated AG- estimated AG)/ ΔHCO3 (24- measured HCO3). If <1 indicates both AG and non AG acidosis

– some of the causes of  acidemia in Short Bowel Syndrome could be GI losses (non gap acidosis), D- lactate acidosis (gap acidosis without elevated lactate) due to bacterial proliferation producing D-lactate

AJG Review article on Short Bowel Syndrome and another review on Short Bowel Syndrome.