title: [Severe metabolic acidosis as a result of 5-oxoproline in acetaminophen use].
abstract: Acetaminophen overdose is a well known cause of liver function disorder and even hepatic failure. Less well known is that even a therapeutic dose of acetaminophen may lead to life-threatening problems. We describe an 84-year-old patient with severe metabolic acidosis and an increased anion gap secondary to 5-oxoproline elevation as a result of acetaminophen use. A systematic approach can help us to determine the cause of a high anion gap metabolic acidosis. In unexplained high anion gap acidosis clinicians should consider the possibility of 5-oxoproline accumulation in patients with risk factors such as acetaminophen use, female sex, malnutrition, infection, diminished liver function or renal failure.
authors.affiliation: Universitair Medisch Centrum Groningen, Afd. Centrale Spoedopvang, the Netherlands. m.holman@cso.umcg.nl
authors.forename: Mirjam
authors.initials: M
authors.lastname: Holman
authors.forename: Jan C
authors.initials: JC
authors.lastname: ter Maaten
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects*; D000136:Acid-Base Equilibrium; D000138:Acidosis / Q000139:chemically induced* / Q000175:diagnosis / Q000209:etiology; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D011761:Pyrrolidonecarboxylic Acid / Q000652:urine*; D016482:Urinalysis
chemical_list: D000082:Acetaminophen; D011761:Pyrrolidonecarboxylic Acid