Related Experiment Video
Updated: May 18, 2026

A Strategy for Sensitive, Large Scale Quantitative Metabolomics
Published on: May 27, 2014
Severe anion gap metabolic acidosis from acetaminophen use secondary to 5-oxoproline (pyroglutamic acid) accumulation
Ladan Zand1, Angela Muriithi, Eric Nelsen
1Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA.
Abstract:
Anion gap metabolic acidosis (AGMA) is commonly encountered in medical practice. Acetaminophen-induced AGMA is, however, not widely recognized. We report 2 cases of high anion gap metabolic acidosis secondary to 5-oxoproline accumulation resulting from acetaminophen consumption: the first case caused by acute one-time ingestion of large quantities of acetaminophen and the second case caused by chronic repeated ingestion in a patient with chronic liver disease. Recognition of this entity facilitated timely diagnosis and effective treatment. Given acetaminophen is commonly used over the counter medication, increased recognition of this adverse effect is of important clinical significance.
Related Concept Videos
Diabetic Ketoacidosis ll: Pathophysiology
Inborn Errors of Metabolism
Hepatic Encephalopathy
Diabetic Ketoacidosis l: Introduction
Phase II Reactions: Glutathione Conjugation and Mercapturic Acid Formation
Several distinctive characteristics distinguish glutathione conjugation from other phase II...
Acute Respiratory Failure-III
