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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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Autores principales: Lanoy, Charlotte, Bouckaert, Yves
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
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.
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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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