title: 5-oxoproline-induced anion gap metabolic acidosis after an acute acetaminophen overdose.
abstract: Metabolic acidosis after acute acetaminophen overdose is typically attributed to either transient lactic acidosis without evidence of hepatic injury or hepatic failure. High levels of the organic acid 5-oxoprolinuria are usually reported in patients with predisposing conditions, such as sepsis, who are treated in a subacute or chronic fashion with acetaminophen. The authors report a case of a 40-year-old woman who developed anion gap metabolic acidosis and somnolence after an acute acetaminophen overdose. Substantial hepatic damage did not occur, which ruled out acetaminophen-induced hepatic insufficiency as a cause of the patient's acidosis or altered mental status. Urinalysis revealed elevated levels of 5-oxoproline, suggesting that the patient's acute acetaminophen overdose was associated with marked anion gap metabolic acidosis due solely to 5-oxoproline without hepatic complications. The acidosis fully resolved with N-acetylcysteine treatment and supportive care including hydration.
authors.affiliation: Division of Medical Toxicology, University of Virginia School of Medicine, P.O. Box 800774, Charlottesville, VA 22908-0774, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Lawrence
authors.forename: Laura K
authors.initials: LK
authors.lastname: Bechtel
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Charlton
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Holstege
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects*; D000111:Acetylcysteine / Q000627:therapeutic use; D000136:Acid-Base Equilibrium; D000138:Acidosis / Q000139:chemically induced* / Q000188:drug therapy / Q000628:therapy; D000208:Acute Disease; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use; D006801:Humans; D011761:Pyrrolidonecarboxylic Acid / Q000378:metabolism*
chemical_list: D018712:Analgesics, Non-Narcotic; D016166:Free Radical Scavengers; D000082:Acetaminophen; D011761:Pyrrolidonecarboxylic Acid; D000111:Acetylcysteine