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[The Sour Patient].

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Summary
This summary is machine-generated.

A 75-year-old woman developed 5-oxoprolin acidosis from therapeutic acetaminophen doses, exacerbated by malnutrition and alcohol abuse. Treatment with bicarbonate and N-acetylcysteine rapidly resolved her metabolic acidosis.

Keywords:
Metabolic acidosisMetabolische AzidoseParacetamolPyroglutaminsäure (5-Oxoprolin)high anion gaphohe Anionenlückeparacetamolpyroglutamic acid (5-oxoproline)

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Area of Science:

  • Internal Medicine
  • Nephrology
  • Toxicology

Background:

  • Metabolic acidosis is a common clinical problem with diverse etiologies.
  • Elevated anion gap metabolic acidosis (AGMA) necessitates a thorough diagnostic workup.
  • 5-oxoprolin acidosis is a rare form of AGMA, often linked to drug exposure or metabolic dysfunction.

Observation:

  • A 75-year-old female presented with symptoms of AGMA.
  • Laboratory evaluation revealed elevated 5-oxoproline levels, indicating 5-oxoprolin acidosis.
  • The patient was receiving therapeutic doses of acetaminophen (paracetamol).
  • Identified risk factors included malnutrition, chronic alcohol abuse, renal insufficiency, and hepatopathy.

Findings:

  • Acetaminophen use, particularly in patients with risk factors, can precipitate 5-oxoprolin acidosis.
  • The underlying mechanism involves glutathione depletion secondary to acetaminophen metabolism.
  • Concomitant malnutrition, alcohol abuse, renal insufficiency, and hepatopathy likely contributed to impaired detoxification pathways.

Implications:

  • This case highlights the importance of considering acetaminophen as a potential cause of AGMA, even at therapeutic doses.
  • Early recognition and management, including acetaminophen cessation and administration of N-acetylcysteine, are crucial for favorable outcomes.
  • Clinicians should assess for risk factors that predispose patients to this condition.