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[Pyroglutamic acidemia associated with acetaminophen].

F J Alados Arboledas1, P de la Oliva Senovilla, Ma J García Muñoz

  • 1Unidad de Cuidados Intensivos Pediátricos, Complejo Hospitalario de Jaén, Spain. fjaladosarbol@supercable.es

Anales De Pediatria (Barcelona, Spain : 2003)
|December 7, 2007
PubMed
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Acetaminophen use may cause pyroglutamic acidemia, a rare condition leading to high anion gap metabolic acidosis. This diagnosis should be considered in patients with unexplained acidosis, especially those on acetaminophen.

Area of Science:

  • Pediatric Nephrology
  • Clinical Toxicology
  • Biochemistry

Background:

  • High anion gap metabolic acidosis (HAGMA) is a critical condition requiring prompt diagnosis.
  • Acetaminophen (paracetamol) is a common antipyretic and analgesic agent.
  • Pyroglutamic acidemia is a rare metabolic disorder characterized by elevated pyroglutamic acid levels.

Observation:

  • A 16-month-old boy, recovering from hemolytic uremic syndrome, presented with abrupt-onset HAGMA unresponsive to standard treatments.
  • Other common causes of HAGMA, including sepsis, lactic acidosis, and salicylate intoxication, were excluded.
  • The patient was concurrently receiving acetaminophen for fever management.

Findings:

  • Blood and urine pyroglutamic acid levels were significantly elevated, confirming pyroglutamic acidemia.

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  • Acetaminophen administration was identified as a potential contributing factor to the metabolic derangement.
  • Normal betahydroxybutyrate, acetoacetate, osmolarity gap, and amino acid levels ruled out other metabolic causes.

    • Implications:

    • This case highlights acetaminophen-induced pyroglutamic acidemia as a critical differential diagnosis for HAGMA in pediatric patients.
    • Clinicians should consider monitoring pyroglutamic acid levels in patients on acetaminophen presenting with unexplained HAGMA.
    • Early recognition and management of pyroglutamic acidemia are crucial to prevent severe complications.