D-lactic acidosis can occur in patients with short bowel syndrome (SBS) when 
excessive malabsorbed carbohydrate (CHO) enters the colon and is metabolized by 
colonic bacteria to D-lactate. D-lactate can be absorbed systemically, and 
increased serum levels are associated with central nervous system toxicity 
manifested by confusion, ataxia, and slurred speech. Current therapy, usually 
directed toward suppressing intestinal bacterial overgrowth and limiting 
ingested CHO, is not always successful. Fecal transplantation, the infusion of 
donor feces into a recipient's intestinal tract, has been used for decades to 
treat recurrent Clostridium difficile infection, and case reports document its 
use in the successful treatment of constipation, diarrhea, and abdominal pain. 
The exact mechanism of action is unknown, but it is surmised that the alteration 
of the intestinal microbiome, as well as the reintroduction of potential 
beneficial microbes, helps mediate disease. Here we present the case of a child 
with SBS and recurrent, debilitating D-lactic acidosis, which was successfully 
treated with fecal transplantation.