Refractory metabolic acidosis in patients with sepsis following hemiarthroplasty for femoral neck fracture: a causative role for paracetamol and flucloxacillin?
The authors report two cases of pyroglutamic acidosis as a result of paracetamol and flucloxacillin therapy in patients with prosthesis infection following hemiarthroplasty for neck of femur fractures. Pyroglutamic acidosis is an important and often unrecognised cause of refractory metabolic acidosis that disproportionately affects older women, and can be caused by drugs such as paracetamol and flucloxacillin in the setting of sepsis, renal failure and malnutrition. Although relatively rare, the widespread use of these drugs in orthopaedic patients confirms the importance of this disorder.
Department of Ageing and Health, Guy's and St. Thomas' Foundation Trust, London, UK. h.amer@doctors.org.uk
Halima
H
Amer
Frances
F
Dockery
Nicholas
N
Barrett
Marc
M
George
Karolina
K
Witek
Jeremy
J
Stanton
Diane
D
Back
D000082:Acetaminophen / Q000009:adverse effects*; D000138:Acidosis / Q000139:chemically induced*; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005436:Floxacillin / Q000009:adverse effects*; D062785:Hemiarthroplasty; D006801:Humans; D011183:Postoperative Complications / Q000188:drug therapy*; D018805:Sepsis / Q000188:drug therapy*
D018712:Analgesics, Non-Narcotic; D000900:Anti-Bacterial Agents; D000082:Acetaminophen; D005436:Floxacillin