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Acquired pyroglutamic acidosis due to long-term dicloxacillin and paracetamol use

An 85-year-old man with a background of transfusion-dependent chronic myelomonocytic leukaemia and chronic kidney disease stage III presented with symptomatic anaemia, acute kidney injury, sepsis and high anion gap metabolic acidosis (HAGMA). Initial treatment with intravenous antibiotics and blood...

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Detalles Bibliográficos
Autores principales: Zand Irani, Anis, Almuwais, Ahmed, Gibbons, Holly
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244275/
https://www.ncbi.nlm.nih.gov/pubmed/32273269
http://dx.doi.org/10.1136/bcr-2019-233306
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author Zand Irani, Anis
Almuwais, Ahmed
Gibbons, Holly
author_facet Zand Irani, Anis
Almuwais, Ahmed
Gibbons, Holly
author_sort Zand Irani, Anis
collection PubMed
description An 85-year-old man with a background of transfusion-dependent chronic myelomonocytic leukaemia and chronic kidney disease stage III presented with symptomatic anaemia, acute kidney injury, sepsis and high anion gap metabolic acidosis (HAGMA). Initial treatment with intravenous antibiotics and blood transfusion was complicated by transfusion-associated circulatory overload, necessitating diuresis and non-invasive ventilation. Despite gradual clinical improvement, the patient’s HAGMA persisted, and no cause was identified on urine testing or renal ultrasound. As the patient was on long-term dicloxacillin for infective endocarditis prophylaxis and regular paracetamol, pyroglutamic acidosis (PGA) (5-oxoproline acidosis) was considered. This was later confirmed with elevated serum levels, and the HAGMA resolved following cessation of these medications. Although considered an uncommon cause of HAGMA, PGA is likely also under-recognised, and to our knowledge, this may be the second reported case in the context of dicloxacillin.
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spelling pubmed-72442752020-06-03 Acquired pyroglutamic acidosis due to long-term dicloxacillin and paracetamol use Zand Irani, Anis Almuwais, Ahmed Gibbons, Holly BMJ Case Rep Findings That Shed New Light on the Possible Pathogenesis of a Disease or an Adverse Effect An 85-year-old man with a background of transfusion-dependent chronic myelomonocytic leukaemia and chronic kidney disease stage III presented with symptomatic anaemia, acute kidney injury, sepsis and high anion gap metabolic acidosis (HAGMA). Initial treatment with intravenous antibiotics and blood transfusion was complicated by transfusion-associated circulatory overload, necessitating diuresis and non-invasive ventilation. Despite gradual clinical improvement, the patient’s HAGMA persisted, and no cause was identified on urine testing or renal ultrasound. As the patient was on long-term dicloxacillin for infective endocarditis prophylaxis and regular paracetamol, pyroglutamic acidosis (PGA) (5-oxoproline acidosis) was considered. This was later confirmed with elevated serum levels, and the HAGMA resolved following cessation of these medications. Although considered an uncommon cause of HAGMA, PGA is likely also under-recognised, and to our knowledge, this may be the second reported case in the context of dicloxacillin. BMJ Publishing Group 2020-04-08 /pmc/articles/PMC7244275/ /pubmed/32273269 http://dx.doi.org/10.1136/bcr-2019-233306 Text en © BMJ Publishing Group Limited 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Findings That Shed New Light on the Possible Pathogenesis of a Disease or an Adverse Effect
Zand Irani, Anis
Almuwais, Ahmed
Gibbons, Holly
Acquired pyroglutamic acidosis due to long-term dicloxacillin and paracetamol use
title Acquired pyroglutamic acidosis due to long-term dicloxacillin and paracetamol use
title_full Acquired pyroglutamic acidosis due to long-term dicloxacillin and paracetamol use
title_fullStr Acquired pyroglutamic acidosis due to long-term dicloxacillin and paracetamol use
title_full_unstemmed Acquired pyroglutamic acidosis due to long-term dicloxacillin and paracetamol use
title_short Acquired pyroglutamic acidosis due to long-term dicloxacillin and paracetamol use
title_sort acquired pyroglutamic acidosis due to long-term dicloxacillin and paracetamol use
topic Findings That Shed New Light on the Possible Pathogenesis of a Disease or an Adverse Effect
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244275/
https://www.ncbi.nlm.nih.gov/pubmed/32273269
http://dx.doi.org/10.1136/bcr-2019-233306
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