Diagnostic dilemma: Rare case of recurrent d-lactic acidosis leading to recurrent acute cardiac failure

d-Lactic acidosis is a rare form of anion gap acidosis and requires a high index of suspicion for appropriate diagnosis and treatment. We report a rare case of short bowel syndrome with recurrent episodes of antibiotic-induced d-lactic acidosis with the presentation of transient severe left ventricular failure. The patient's cardiac function returned to normal with the resolution of acidosis under conservative management and a low carbohydrate diet. d-Lactic acidosis has been known to be associated with only neurological symptoms, and cardiac failure has not been previously reported.