Profound metabolic acidosis from pyroglutamic acidemia: an underappreciated cause of high anion gap metabolic acidosis.
نویسندگان
چکیده
The workup of the emergency patient with a raised anion gap metabolic acidosis includes assessment of the components of “MUDPILES” (methanol; uremia; diabetic ketoacidosis; paraldehyde; isoniazid, iron or inborn errors of metabolism; lactic acid; ethylene glycol; salicylates). This approach is usually sufficient for the majority of cases in the emergency department; however, there are many other etiologies not addressed in this mnemonic. Organic acids including 5-oxoproline (pyroglutamic acid) are rare but important causes of anion gap metabolic acidosis. We present the case of a patient with profound metabolic acidosis with raised anion gap, due to pyroglutamic acid in the setting of malnutrition and chronic ingestion of acetaminophen.
منابع مشابه
5-Oxoproline as a cause of high anion gap metabolic acidosis: an uncommon cause with common risk factors.
High anion gap metabolic acidosis might be caused by 5-oxoproline (pyroglutamic acid). As it is very easy to treat, it might be worth drawing attention to this uncommon and probably often overlooked diagnosis. We present three cases of high anion gap metabolic acidosis due to 5-oxoproline seen within a period of six months.
متن کاملPyroglutamic acidemia in an adult patient.
Pyroglutamic acidemia, a rare metabolic disorder, usually appears in infancy. It is characterized by retardation, ataxia, hemolytic anemia, and chronic acidosis and is caused by a marked deficiency of glutathione synthetase (EC 6.3.2.3) activity. This disease is inherited as an autosomal recessive trait, but the clinical condition is also detected in heterozygotes. We report an unusual case of ...
متن کاملIncreased anion gap metabolic acidosis as a result of 5-oxoproline (pyroglutamic acid): a role for acetaminophen.
The endogenous organic acid metabolic acidoses that occur commonly in adults include lactic acidosis; ketoacidosis; acidosis that results from the ingestion of toxic substances such as methanol, ethylene glycol, or paraldehyde; and a component of the acidosis of kidney failure. Another rare but underdiagnosed cause of severe, high anion gap metabolic acidosis in adults is that due to accumulati...
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Dyspnea and elevated anion gap metabolic acidosis are common presenting problems in critically ill patients. In certain cases, however, the standard workup for these problems does not reveal an etiology, and other diagnoses must be considered. We describe a woman who presented with dyspnea and severe acidemia due to a profound metabolic acidosis, who was subsequently found to have toluene toxic...
متن کامل5-Oxoproline (pyroglutamic) acidosis associated with chronic acetaminophen use.
M etabolic acidosis is a common acid-base disturbance in hospitalized patients. Distinguishing anion gap from non–anion gap metabolic acidosis is a very helpful exercise and enables the clinician to narrow the etiology of the particular acidosis. The use of the anion gap was popularized in an article by Emmett and Narins (1). Over the past few years, the list of conditions that can cause an ani...
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ورودعنوان ژورنال:
- CJEM
دوره 12 5 شماره
صفحات -
تاریخ انتشار 2010