• Rev Med Interne · Feb 2018

    Case Reports

    [Acetaminophen induced 5-oxoproline acidosis: An uncommon case of high anion gap metabolic acidosis].

    • A Lanot, P Henri, M Nowoczyn, M H Read, C Maucorps, M Sassier, and T Lobbedez.
    • Néphrologie, CUMR, CHU de Caen, 14033 Caen cedex 9, France; Normandie université, Unicaen, UFR de médecine, 2, rue des Rochambelles, 14033 Caen cedex 9, France. Electronic address: lanot-a@chu-caen.fr.
    • Rev Med Interne. 2018 Feb 1; 39 (2): 122-126.

    AbstractThe most common causes of high anion gap metabolic acidosis (HAGMA) are lactic acidosis, ketoacidosis, and intoxications. Nevertheless, clinicians can be faced with unexplained HAGMA, with a need to look for less common etiologies. We describe a case of 5-oxoproline (pyroglutamate) acidosis due to chronic acetaminophen ingestion at therapeutic dose in a 79-year-old inpatient. The pathophysiology of this condition is detailed, with abnormalities in the gamma-glutamyl cycle due to acetaminophen ingestion and severe chronic morbidities, resulting in glutathione and cysteine deficiency and then accumulation of 5-oxoproline. In HAGMA, when usual causes have been excluded, 5-oxoproline acidosis should be suspected in patients with chronic morbidities and acetaminophen ingestion. This diagnosis should be kept in mind because it generally resolves quickly with cessation of acetaminophen and administration of intravenous fluids.Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

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