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Pyroglutamic acid-induced metabolic acidosis: a case report
Acta Clinica Belgica
|April 4, 2014
Summary
High anion gap metabolic acidosis from pyroglutamic acid is a rare complication of acetaminophen. This case highlights its development during flucloxacillin treatment for sepsis, emphasizing the role of glutathione depletion.
Area of Science:
- Biochemistry
- Toxicology
- Clinical Medicine
Background:
- High anion gap metabolic acidosis can arise from pyroglutamic acid (5-oxoproline) accumulation.
- Acetaminophen use depletes glutathione, a risk factor for 5-oxoproline buildup and encephalopathy.
- Severe sepsis and certain medications like flucloxacillin can exacerbate glutathione depletion.
Observation:
- A 55-year-old woman on acetaminophen for fever developed symptomatic 5-oxoproline overproduction.
- This occurred during treatment for severe sepsis with flucloxacillin.
- The patient presented with moderate to severe encephalopathy.
Findings:
- The patient's condition was linked to combined acetaminophen and flucloxacillin therapy, leading to glutathione depletion.
- Accumulated 5-oxoproline caused high anion gap metabolic acidosis and encephalopathy.
- Hemodialysis effectively cleared the pyroglutamic acid, improving the patient's clinical status.
Implications:
- This case underscores the potential for severe pyroglutamic acid accumulation and acidosis with combined acetaminophen and flucloxacillin use in sepsis.
- It highlights the importance of recognizing glutathione depletion as a critical factor in drug-induced toxicities.
- Early recognition and intervention, including hemodialysis, are crucial for managing this rare but serious complication.
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