Pyroglutamic Acidosis – An Underrecognised Entity Associated with Acetaminophen Use

Pyroglutamic acidosis (PGA) is an underrecognized entity characterised by raised anion gap metabolic acidosis (RAGMA) and urinary hyper-excretion of pyroglutamic acid. It is frequently associated with chronic acetaminophen (APAP) ingestion. We report the case of a 73-year-old man with invasive pulmo...

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Autores principales: Ng, Wincy Wing-Sze, Tong, Hok-Fung, Ng, Wai-Yan, Yeung, Joshua Ka-Ho, Young, Joyce Kit-Yu, Woo, Raymond Kam-Wing, Wong, Maureen Mo-Lin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sciendo 2023
Materias:
Case Report
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10448446/
https://www.ncbi.nlm.nih.gov/pubmed/37635852
http://dx.doi.org/10.2478/rjaic-2023-0004
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author Ng, Wincy Wing-Sze
Tong, Hok-Fung
Ng, Wai-Yan
Yeung, Joshua Ka-Ho
Young, Joyce Kit-Yu
Woo, Raymond Kam-Wing
Wong, Maureen Mo-Lin
author_facet Ng, Wincy Wing-Sze
Tong, Hok-Fung
Ng, Wai-Yan
Yeung, Joshua Ka-Ho
Young, Joyce Kit-Yu
Woo, Raymond Kam-Wing
Wong, Maureen Mo-Lin
author_sort Ng, Wincy Wing-Sze
collection PubMed
description Pyroglutamic acidosis (PGA) is an underrecognized entity characterised by raised anion gap metabolic acidosis (RAGMA) and urinary hyper-excretion of pyroglutamic acid. It is frequently associated with chronic acetaminophen (APAP) ingestion. We report the case of a 73-year-old man with invasive pulmonary aspergillosis treated with voriconazole and APAP for analgesia with a cumulative dose of 160 g over 40 days. PGA was suspected as he developed severe RAGMA and common causes were excluded. Diagnosis was confirmed via urinary organic acid analysis which showed significant hyper-excretion of pyroglutamic acid. APAP was discontinued, and N-acetylcysteine (NAC) was administered. His RAGMA rapidly resolved following treatment.
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spelling pubmed-104484462023-08-25 Pyroglutamic Acidosis – An Underrecognised Entity Associated with Acetaminophen Use Ng, Wincy Wing-Sze Tong, Hok-Fung Ng, Wai-Yan Yeung, Joshua Ka-Ho Young, Joyce Kit-Yu Woo, Raymond Kam-Wing Wong, Maureen Mo-Lin Rom J Anaesth Intensive Care Case Report Pyroglutamic acidosis (PGA) is an underrecognized entity characterised by raised anion gap metabolic acidosis (RAGMA) and urinary hyper-excretion of pyroglutamic acid. It is frequently associated with chronic acetaminophen (APAP) ingestion. We report the case of a 73-year-old man with invasive pulmonary aspergillosis treated with voriconazole and APAP for analgesia with a cumulative dose of 160 g over 40 days. PGA was suspected as he developed severe RAGMA and common causes were excluded. Diagnosis was confirmed via urinary organic acid analysis which showed significant hyper-excretion of pyroglutamic acid. APAP was discontinued, and N-acetylcysteine (NAC) was administered. His RAGMA rapidly resolved following treatment. Sciendo 2023-04-20 /pmc/articles/PMC10448446/ /pubmed/37635852 http://dx.doi.org/10.2478/rjaic-2023-0004 Text en © 2023 Wincy Wing-Sze Ng et al., published by sciendo https://creativecommons.org/licenses/by-nc-nd/3.0/This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
spellingShingle Case Report
Ng, Wincy Wing-Sze
Tong, Hok-Fung
Ng, Wai-Yan
Yeung, Joshua Ka-Ho
Young, Joyce Kit-Yu
Woo, Raymond Kam-Wing
Wong, Maureen Mo-Lin
Pyroglutamic Acidosis – An Underrecognised Entity Associated with Acetaminophen Use
title Pyroglutamic Acidosis – An Underrecognised Entity Associated with Acetaminophen Use
title_full Pyroglutamic Acidosis – An Underrecognised Entity Associated with Acetaminophen Use
title_fullStr Pyroglutamic Acidosis – An Underrecognised Entity Associated with Acetaminophen Use
title_full_unstemmed Pyroglutamic Acidosis – An Underrecognised Entity Associated with Acetaminophen Use
title_short Pyroglutamic Acidosis – An Underrecognised Entity Associated with Acetaminophen Use
title_sort pyroglutamic acidosis – an underrecognised entity associated with acetaminophen use
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10448446/
https://www.ncbi.nlm.nih.gov/pubmed/37635852
http://dx.doi.org/10.2478/rjaic-2023-0004
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