Metabolic Acidosis Due To Pyroglutamic Acid

Area of Science:

• Biochemistry
• Clinical Medicine
• Toxicology

Background:

• Metabolic acidosis is a common clinical issue characterized by decreased serum HCO3-.
• It's classified into normal and high anion gap types, with the latter having diverse causes.
• Pyroglutamic acidemia is a rare cause of high anion gap metabolic acidosis.

Purpose of the Study:

• To report a case of pyroglutamic acidosis in an adult.
• To highlight the association between acetaminophen misuse and pyroglutamic acidosis.
• To emphasize the importance of considering pyroglutamic acidemia in unexplained high anion gap metabolic acidosis.

Main Methods:

• Case report of a woman with acute and chronic acetaminophen misuse.
• Clinical assessment and laboratory evaluation for metabolic acidosis.
• Differential diagnosis to exclude other causes of high anion gap metabolic acidosis.

Main Results:

• The patient presented with high anion gap metabolic acidosis.
• Acetaminophen misuse was identified as the likely cause of pyroglutamic acid accumulation.
• Other common causes of metabolic acidosis were ruled out.

Conclusions:

• Acetaminophen misuse can lead to pyroglutamic acid accumulation and metabolic acidosis.
• Pyroglutamic acidosis should be considered in patients with unexplained high anion gap metabolic acidosis.
• Reporting such cases aids in understanding and diagnosing this condition.