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Pyroglutamic Acidosis - An Underrecognised Entity Associated with Acetaminophen Use.

Wincy Wing-Sze Ng1, Hok-Fung Tong2, Wai-Yan Ng2

  • 1Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong Special Administrative Region, China.

Romanian Journal of Anaesthesia and Intensive Care
|August 28, 2023
PubMed
Summary
This summary is machine-generated.

Pyroglutamic acidosis (PGA), linked to acetaminophen (APAP) use, causes metabolic acidosis. This case highlights APAP

Keywords:
5-oxoprolinuriaacetaminophenparacetamolpұroglutamic acidosisvoriconazole

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Area of Science:

  • Medical Case Study
  • Toxicology
  • Nephrology

Background:

  • Pyroglutamic acidosis (PGA) is an underrecognized condition causing metabolic acidosis.
  • It is often associated with chronic acetaminophen (APAP) use.
  • Patients present with raised anion gap metabolic acidosis (RAGMA) and excessive urinary pyroglutamic acid excretion.

Purpose of the Study:

  • To report a case of PGA in a patient treated with voriconazole and APAP.
  • To illustrate the diagnostic process and successful management of drug-induced PGA.

Main Methods:

  • Clinical case presentation of a 73-year-old man.
  • Diagnostic workup included exclusion of common causes for RAGMA.
  • Confirmation via urinary organic acid analysis.

Main Results:

  • The patient developed severe RAGMA during voriconazole and APAP treatment.
  • Urinary organic acid analysis confirmed significant pyroglutamic acid hyper-excretion.
  • Discontinuation of APAP and administration of N-acetylcysteine (NAC) led to rapid resolution of RAGMA.

Conclusions:

  • Chronic acetaminophen (APAP) ingestion can precipitate pyroglutamic acidosis (PGA).
  • Prompt diagnosis and discontinuation of the offending agent (APAP) are crucial.
  • N-acetylcysteine (NAC) may be beneficial in managing APAP-induced PGA.