Pyroglutamic acid-induced metabolic acidosis: a case report.
High anion gap metabolic acidosis due to pyroglutamic acid (5-oxoproline) is a rare complication of acetaminophen treatment (which depletes glutathione stores) and is often associated with clinically moderate to severe encephalopathy. Acquired 5-oxoprolinase deficiency (penicillins) or the presence of other risk factors of glutathione depletion such as malnutrition or sepsis seems to be necessary for symptoms development. We report the case of a 55-year-old women who developed a symptomatic overproduction of 5-oxoproline during flucloxacillin treatment for severe sepsis while receiving acetaminophen for fever control. Hemodialysis accelerated the clearance of the accumulated organic acid, and was followed by a sustained clinical improvement.
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Luyasu
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Wamelink
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Galanti
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Dive
D000082:Acetaminophen / Q000009:adverse effects; D000138:Acidosis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D058633:Antipyretics / Q000009:adverse effects; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology; D005436:Floxacillin / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D011761:Pyrrolidonecarboxylic Acid / Q000009:adverse effects*
D000900:Anti-Bacterial Agents; D058633:Antipyretics; D000082:Acetaminophen; D005436:Floxacillin; D011761:Pyrrolidonecarboxylic Acid
Acetaminophen/adverse effects,; Acidosis/chemically induced,; Pyrrolidonecarboxylic acid/metabolism,; Renal dialysis; Sepsis/complications,