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Metabolic acidosis and 5-oxoprolinuria induced by flucloxacillin and acetaminophen: a case report
BACKGROUND: Frequent causes of high anion gap metabolic acidosis are well known: ethanol, methanol, and ethylene glycol intoxication; hyperglycemia; lactic or D-lactic acidosis; and impaired renal function. There are other causes, less frequent but also important. This report illustrates a rare case...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918112/ https://www.ncbi.nlm.nih.gov/pubmed/27339215 http://dx.doi.org/10.1186/s13256-016-0964-x |
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author | Lanoy, Charlotte Bouckaert, Yves |
author_facet | Lanoy, Charlotte Bouckaert, Yves |
author_sort | Lanoy, Charlotte |
collection | PubMed |
description | BACKGROUND: Frequent causes of high anion gap metabolic acidosis are well known: ethanol, methanol, and ethylene glycol intoxication; hyperglycemia; lactic or D-lactic acidosis; and impaired renal function. There are other causes, less frequent but also important. This report illustrates a rare case of a patient with increased anion gap metabolic acidosis due to a deficit of the γ-glutamyl cycle that led to 5-oxoproline (acid pyroglutamic) accumulation. CASE PRESENTATION: An 82-year-old white woman was admitted to our intensive care unit because of septic shock caused by right knee methicillin-sensitive Staphylococcus aureus-induced arthritis. She was treated for 10 days with flucloxacillin and rifampicin and developed metabolic acidosis with high anion gap. Her test results for methanol, ethanol, ethylene glycol, and acetylsalicylic acid were negative. Her glycemia, lactate level, and renal function were normal. However, the result of a urinary assay for pyroglutamate was positive. We concluded that the patient had metabolic acidosis induced by accumulation of 5-oxoproline. We modified her antibiotic treatment, administered acetylcysteine, and her acidosis resolved. CONCLUSIONS: 5-Oxoprolinuria (pyroglutamic acid accumulation) is a rare, probably underdiagnosed cause of transient metabolic acidosis with increased anion gap. |
format | Online Article Text |
id | pubmed-4918112 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-49181122016-06-24 Metabolic acidosis and 5-oxoprolinuria induced by flucloxacillin and acetaminophen: a case report Lanoy, Charlotte Bouckaert, Yves J Med Case Rep Case Report BACKGROUND: Frequent causes of high anion gap metabolic acidosis are well known: ethanol, methanol, and ethylene glycol intoxication; hyperglycemia; lactic or D-lactic acidosis; and impaired renal function. There are other causes, less frequent but also important. This report illustrates a rare case of a patient with increased anion gap metabolic acidosis due to a deficit of the γ-glutamyl cycle that led to 5-oxoproline (acid pyroglutamic) accumulation. CASE PRESENTATION: An 82-year-old white woman was admitted to our intensive care unit because of septic shock caused by right knee methicillin-sensitive Staphylococcus aureus-induced arthritis. She was treated for 10 days with flucloxacillin and rifampicin and developed metabolic acidosis with high anion gap. Her test results for methanol, ethanol, ethylene glycol, and acetylsalicylic acid were negative. Her glycemia, lactate level, and renal function were normal. However, the result of a urinary assay for pyroglutamate was positive. We concluded that the patient had metabolic acidosis induced by accumulation of 5-oxoproline. We modified her antibiotic treatment, administered acetylcysteine, and her acidosis resolved. CONCLUSIONS: 5-Oxoprolinuria (pyroglutamic acid accumulation) is a rare, probably underdiagnosed cause of transient metabolic acidosis with increased anion gap. BioMed Central 2016-06-23 /pmc/articles/PMC4918112/ /pubmed/27339215 http://dx.doi.org/10.1186/s13256-016-0964-x Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Report Lanoy, Charlotte Bouckaert, Yves Metabolic acidosis and 5-oxoprolinuria induced by flucloxacillin and acetaminophen: a case report |
title | Metabolic acidosis and 5-oxoprolinuria induced by flucloxacillin and acetaminophen: a case report |
title_full | Metabolic acidosis and 5-oxoprolinuria induced by flucloxacillin and acetaminophen: a case report |
title_fullStr | Metabolic acidosis and 5-oxoprolinuria induced by flucloxacillin and acetaminophen: a case report |
title_full_unstemmed | Metabolic acidosis and 5-oxoprolinuria induced by flucloxacillin and acetaminophen: a case report |
title_short | Metabolic acidosis and 5-oxoprolinuria induced by flucloxacillin and acetaminophen: a case report |
title_sort | metabolic acidosis and 5-oxoprolinuria induced by flucloxacillin and acetaminophen: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918112/ https://www.ncbi.nlm.nih.gov/pubmed/27339215 http://dx.doi.org/10.1186/s13256-016-0964-x |
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