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Fig. 4 | Journal of Translational Medicine

Fig. 4

From: Examining clinical similarities between myalgic encephalomyelitis/chronic fatigue syndrome and d-lactic acidosis: a systematic review

Fig. 4

Overview of mechanisms in d-lactic acidosis. Legend. Summary of contextual factors, triggers and proposed mechanisms leading to d-lactic acidosis (d-la). A presentation of d-la requires an increase in d-lactate absorption. The proposed mechanisms of increased d-lactate production can be through (1) bacterial dysbiosis and/or (2) endogenous production of d-lactate. Simultaneous to the increased absorption, patients who present with d-la also require (3) slowed metabolism of d-lactate. Hence, the d-lactate production exceeds the body’s metabolic and/or excretion capacity. Short bowel syndrome (SBS); d-2-hydroxy acid dehydrogenase (d-2-HDH); adenosine triphosphate (ATP); tricarboxylic acid (TCA)

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