d-Lactic acidosis is an uncommon cause of acidosis that occurs in patients with short bowel syndrome (SBS). Reduced intestinal absorption surface leads to carbohydrate malabsorption, fermented by abnormal colonic bacterial flora, resulting in elevated d-lactate levels. It should be suspected in SBS patients who exhibit typical neurological symptoms without other apparent causes, along with metabolic acidosis with normal l-lactate levels. Treatment involves correcting acidosis and managing bacterial overgrowth with non-absorbable antibiotics. This report presents a case of a patient on teduglutide for SBS who experienced an episode of d-lactic acidosis. To date, there are no documented cases in the literature of similar episodes in adult patients undergoing therapy with GLP2 analogs.