Metabolic Acidosis Due To Pyroglutamic Acid

  • Maria João Raposo Linhares Serpa Internal Medicine Department, Hospital Beatriz Ângelo, Loures, Portugal
  • Luís Falcão Nephrology Department, Hospital Beatriz Ângelo, Loures, Portugal
  • Susana Franco Internal Medicine Department, Hospital Beatriz Ângelo, Loures, Portugal
  • Diana Repolho Internal Medicine Department, Hospital Beatriz Ângelo, Loures, Portugal
  • Nuno Ribeiro Ferreira Internal Medicine Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal

Keywords

High anion gap metabolic acidosis, 5-oxoprolinemia, pyroglutamic acidemia, acetaminophen, paracetamol

Abstract

Metabolic acidosis is a common clinical disturbance due to increased plasma acidity caused by a primary decrease in serum HCO3- concentration. It is classified as normal or high anion gap metabolic acidosis. High anion gap metabolic acidosis can result from either a decrease in unmeasured cations (K+, Ca2+, Mg2+) or an increase in unmeasured anions (PO43-, albumin). However, other anions such as lactic acid or keto acids may cause this acid-base disorder. It can also result from renal failure and intoxication (salicylate, methanol, ethylene glycol), or more rarely, from massive rhabdomyolysis and pyroglutamic (5-oxoproline) acidemia. Acidemia due to pyroglutamic acid should be considered when no other aetiology is found. High anion gap metabolic acidosis is diagnosed in children with inherited defects in enzymes of the γ-glutamyl cycle. In adults, this disorder from pyroglutamic acid has been described in association with chronic acetaminophen misuse. We report a case of pyroglutamic acidosis in a woman with acute misuse of acetaminophen concurrent with chronic use. .

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  • Published: 2018-09-27

    Issue: Vol 5 No 10 (view)

    Section: Articles

    How to cite:
    Serpa, M. J., Falcão, L., Franco, S., Repolho, D., & Ferreira, N. (2018). Metabolic Acidosis Due To Pyroglutamic Acid. European Journal of Case Reports in Internal Medicine, 5(10). https://doi.org/https://doi.org/10.12890/2018_000949