• Philippe G Jorens, Hendrik E Demey, Paul J C Schepens, Vera Coucke, Gert A Verpooten, M M Couttenye, and Viviane Van Hoof.
• Department of Intensive Care Medicine, University Hospital of Antwerp, Edegem, Belgium. Philippe.Jorens@uza.be
• J. Toxicol. Clin. Toxicol. 2004 Jan 1;42(2):163-9.

ObjectiveTo report a case of D-lactic acid acidosis owing to massive oral ingestion of propylene glycol.Case ReportA 72-year old man with known congestive failure was admitted to the ICU with encephalopathy. Twelve hours prior to admission he had erroneously ingested a large amount of propylene glycol (PG). The laboratory revealed high anion gap (anion gap = 27 meq/l) acidosis (arterial pH = 7.16) and an increased osmolal gap. Toxicological analysis revealed a low serum propylene glycol level. Biochemical analysis indicated that very high amounts of D-lactic acid (up to 110 mmol/l), but not of the usual type of L-lactic acid, were responsible for the metabolic acidosis. Hemodialysis was initiated and associated with a decline of both the acidosis and D-lactic acid levels. The patient regained conciousness.ConclusionIngestion of massive doses of propylene glycol, previously not reported as a cause of D-lactic acidosis, should be added to the differential diagnosis of this rare condition.

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