Drunken lamb syndrome (DLS) is a fatal disease of unknown aetiology affecting young lambs. In 2011, a prospective on farm cohort study was carried out to investigate the epidemiology and pathophysiology of DLS. Ten cases from a cohort of 1635 crossbred and pure Welsh Mountain lambs were identified as having DLS on the basis of characteristic clinical signs. Renal histopathology demonstrated nephrosis in all 10 cases. Some cases also demonstrated concurrent intestinal pathology. The cases were significantly smaller than the cohort, nine out of the 10 were twins, and they all demonstrated a severe metabolic acidosis characterised by elevated D-lactate. This study demonstrates that D-lactate—probably initiated by the overgrowth of intestinal microorganisms—appears to be the cause of the metabolic acidosis seen in cases of DLS, and to be responsible for the clinical signs seen. It is unclear as to the significance of the nephrosis lesions, and the name ‘Lamb Nephrosis’ may be misleading. Treatment may be possible using solutions of sodium bicarbonate.