What is the clinical significance of 5-oxoproline (pyroglutamic acid) in high anion gap metabolic acidosis following paracetamol (acetaminophen) exposure?

@article{Liss2013WhatIT,
  title={What is the clinical significance of 5-oxoproline (pyroglutamic acid) in high anion gap metabolic acidosis following paracetamol (acetaminophen) exposure?},
  author={D. Liss and M. Paden and E. Schwarz and M. Mullins},
  journal={Clinical Toxicology},
  year={2013},
  volume={51},
  pages={817 - 827}
}
Abstract Context. Paracetamol (acetaminophen) ingestion is the most frequent pharmaceutical overdose in the developed world. Metabolic acidosis sometimes occurs, but the acidosis is infrequently persistent or severe. A growing number of case reports and case series describe high anion gap metabolic acidosis (HAGMA) following paracetamol exposure with subsequent detection or measurement of 5-oxoproline (also called pyroglutamic acid) in blood, urine, or both. Typically 5-oxoprolinuria or 5… Expand
Acetaminophen-induced anion gap metabolic acidosis secondary to 5-oxoproline: a case report
TLDR
5-oxoproline acidosis is an uncommon cause of high anion gap metabolic acidosis; however, it is likely that it is under-diagnosed as awareness of the condition remains low and testing can only be performed at specialized laboratories. Expand
Acidose à la 5-oxoproline induite par le paracétamol : une cause rare d’acidose métabolique à trou anionique augmenté
TLDR
5-oxoproline (pyroglutamate) acidosis due to chronic acetaminophen ingestion at therapeutic dose in a 79-year-old inpatient is described, keeping in mind that this diagnosis should be kept in mind because it generally resolves quickly with cessation ofacetaminophen and administration of intravenous fluids. Expand
[Acetaminophen induced 5-oxoproline acidosis: An uncommon case of high anion gap metabolic acidosis].
TLDR
5-oxoproline (pyroglutamate) acidosis due to chronic acetaminophen ingestion at therapeutic dose in a 79-year-old inpatient is described, keeping in mind that this diagnosis should be kept in mind because it generally resolves quickly with cessation ofacetaminophen and administration of intravenous fluids. Expand
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TLDR
A simple, cost effective, and fast capillary electrophoresis method with diode array detection (DAD) for simultaneous measurement of both paracetamol (acetaminophen) and 5‐oxoproline in serum was developed and validated and is highly suitable for clinical toxicology laboratory diagnostic, allowing rapid quantification of acidosis inducing organic acids present in cases of par acetamol overdose. Expand
Transient 5-oxoprolinuria: unusually high anion gap acidosis in an infant
TLDR
An unusual paediatric case of transient 5-oxoprolinuria presenting during an episode of severe sepsis with concomitant paracetamol use is illustrated, highlighting the importance of investigating a high anion gap such that unusual diagnoses are not missed. Expand
Metabolic acidosis caused by concomitant use of paracetamol (acetaminophen) and flucloxacillin? A case report and a retrospective study
TLDR
The prevalence of metabolic acidosis is very low, the only patient identified with the interaction was recognised during normal clinical care and it is concluded that automatic alerts based on simultaneous use of paracetamol and flucloxacillin will generate too many signals. Expand
Minding The Gap: Severe Anion Gap Metabolic Acidosis Associated With 5-Oxoproline Secondary To Chronic Acetaminophen Use
TLDR
Clinicians should consider 5-oxoprolemia in patients who present with an otherwise unexplained anion gap metabolic acidosis and a history of chronic acetaminophen use, as well as quantitative profile of urinary organic acids to measure 5-Oxoproline, an intermediate organic acid in the gamma-glutamyl cycle. Expand
5-Oxoproline concentrations in acute acetaminophen overdose
TLDR
It is believed that inherited enzyme deficiencies more likely explain cases of 5-oxoprolinemia as well as acute acetaminophen overdose, which generally results in normal 5-Oxoproline concentrations with some patients having slightly elevated 5- oxoprolines concentrations. Expand
Severe metabolic acidosis induced by 5-oxoproline accumulation after paracetamol and flucloxacillin administration
In this case report we present a singular case of metabolic acidosis seen in a 78-year-old female who was admitted to the intensive care unit (ICU) with dyspnoea, tachypnoea and tachycardia due toExpand
Pyroglutamic acid-induced metabolic acidosis: a case report
TLDR
The case of a 55-year-old women who developed a symptomatic overproduction of 5-oxoproline during flucloxacillin treatment for severe sepsis while receiving acetaminophen for fever control is reported. Expand
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