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Malnourishment-Associated Acetaminophen Toxicity in Pregnancy
Aaron M Dom1, Rebecca Royzer, Courtney Olson-Chen
1Department of Obstetrics and Gynecology, University of Rochester Medical Center, the University of Rochester School of Medicine and Dentistry, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York.
Obstetrics and Gynecology
|April 8, 2021
Summary
Acetaminophen use in pregnancy, especially with malnutrition, can lead to metabolic acidosis due to 5-oxoproline accumulation. N-acetylcysteine effectively treated this condition, highlighting its role as an antidote.
Area of Science:
- Obstetrics and Gynecology
- Clinical Biochemistry
- Toxicology
Background:
- Acetaminophen (APAP) is frequently used during pregnancy.
- Chronic APAP use can deplete glutathione, leading to 5-oxoproline buildup.
- This accumulation can precipitate metabolic acidosis, a serious condition.
Observation:
- A case of a malnourished pregnant woman with chronic APAP use presented with severe metabolic acidosis.
- Other causes were excluded, and elevated urine 5-oxoproline levels confirmed 5-oxoprolinemia.
- The patient experienced abdominal pain as a symptom.
Findings:
- The patient received N-acetylcysteine (NAC) as a therapeutic intervention.
- NAC administration led to the complete resolution of the metabolic acidosis.
- This demonstrates the efficacy of NAC in treating APAP-induced 5-oxoprolinemia.
Implications:
- Clinicians should consider 5-oxoprolinemia in pregnant patients with metabolic acidosis, particularly those with malnutrition and APAP exposure.
- Caution is advised with APAP use in malnourished pregnant individuals.
- N-acetylcysteine is a potential antidote for this condition, warranting further clinical consideration.
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