5-Oxoproline (pyroglutamic) acidosis associated with chronic acetaminophen use.
نویسندگان
چکیده
M etabolic acidosis is a common acid-base disturbance in hospitalized patients. Distinguishing anion gap from non–anion gap metabolic acidosis is a very helpful exercise and enables the clinician to narrow the etiology of the particular acidosis. The use of the anion gap was popularized in an article by Emmett and Narins (1). Over the past few years, the list of conditions that can cause an anion gap metabolic acidosis has expanded. Mehta et al recently developed a “new mnemonic for the 21st century” to add three forms of anion gap metabolic acidosis not included in several popular mnemonics and to delete several obsolete causes (2). The new mnemonic is GOLD MARK, an acronym for glycols (ethylene and propylene), oxoproline (5-oxoproline also called pyroglutamic acid), L-lactate, D-lactate, methanol, aspirin, renal failure, and ketoacidosis. The new additions are D-lactic acidosis, typically seen in patients with short gut syndromes; the accumulation of propylene glycol, a common diluent for intravenous medications; and 5-oxoproline, an increasingly recognized disorder most commonly associated with chronic acetaminophen ingestion. We report a case of 5-oxoproline acidosis in a woman with a history of chronic acetaminophen use.
منابع مشابه
Acetaminophen toxicity and 5-oxoproline (pyroglutamic acid): a tale of two cycles, one an ATP-depleting futile cycle and the other a useful cycle.
The acquired form of 5-oxoproline (pyroglutamic acid) metabolic acidosis was first described in 1989 and its relationship to chronic acetaminophen ingestion was proposed the next year. Since then, this cause of chronic anion gap metabolic acidosis has been increasingly recognized. Many cases go unrecognized because an assay for 5-oxoproline is not widely available. Most cases occur in malnouris...
متن کاملIncreased anion gap metabolic acidosis as a result of 5-oxoproline (pyroglutamic acid): a role for acetaminophen.
The endogenous organic acid metabolic acidoses that occur commonly in adults include lactic acidosis; ketoacidosis; acidosis that results from the ingestion of toxic substances such as methanol, ethylene glycol, or paraldehyde; and a component of the acidosis of kidney failure. Another rare but underdiagnosed cause of severe, high anion gap metabolic acidosis in adults is that due to accumulati...
متن کاملAcetaminophen-induced anion gap metabolic acidosis secondary to 5-oxoproline: a case report
INTRODUCTION 5-oxoproline (pyroglutamic acid), an organic acid intermediate of the gamma-glutamyl cycle, is a rare cause of high anion gap metabolic acidosis. Acetaminophen and several other drugs have been implicated in the development of transient 5-oxoprolinemia in adults. We believe that reporting all cases of 5-oxoprolinemia will contribute to a better understanding of this disease. Here, ...
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The workup of the emergency patient with a raised anion gap metabolic acidosis includes assessment of the components of “MUDPILES” (methanol; uremia; diabetic ketoacidosis; paraldehyde; isoniazid, iron or inborn errors of metabolism; lactic acid; ethylene glycol; salicylates). This approach is usually sufficient for the majority of cases in the emergency department; however, there are many othe...
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عنوان ژورنال:
- Proceedings
دوره 23 1 شماره
صفحات -
تاریخ انتشار 2010