Pyroglutamic acid and high anion gap: Looking through the keyhole?

2000 ◽  
Vol 28 (6) ◽  
pp. 2140-2141 ◽  
Author(s):  
Barry A. Mizock ◽  
Carter Mecher
Keyword(s):  
Pyroglutamic Acid ◽  
Anion Gap

Recurrent High Anion Gap Metabolic Acidosis Secondary to 5-Oxoproline (Pyroglutamic Acid)

2005 ◽  
Vol 46 (1) ◽  
pp. e4-e10 ◽  
Author(s):  
Prayus Tailor ◽  
Tuhina Raman ◽  
Cheryl L. Garganta ◽  
Runa Njalsson ◽  
Katarina Carlsson ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Pyroglutamic Acid ◽  
Anion Gap

scholarly journals Profound metabolic acidosis from pyroglutamic acidemia: an underappreciated cause of high anion gap metabolic acidosis

CJEM ◽  
2010 ◽  
Vol 12 (05) ◽  
pp. 449-452 ◽  
Author(s):  
Thomas J. Green ◽  
Jan Jaap Bijlsma ◽  
David D. Sweet
Keyword(s):  
Emergency Department ◽  
Lactic Acid ◽  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Inborn Errors Of Metabolism ◽  
Pyroglutamic Acid ◽  
Anion Gap ◽  
Emergency Patient ◽  
Inborn Errors ◽  
Chronic Ingestion

ABSTRACTThe workup of the emergency patient with a raised anion gap metabolic acidosis includes assessment of the components of “MUDPILES” (methanol; uremia; diabetic ketoacidosis; paraldehyde; isoniazid, iron or inborn errors of metabolism; lactic acid; ethylene glycol; salicylates). This approach is usually sufficient for the majority of cases in the emergency department; however, there are many other etiologies not addressed in this mnemonic. Organic acids including 5-oxoproline (pyroglutamic acid) are rare but important causes of anion gap metabolic acidosis. We present the case of a patient with profound metabolic acidosis with raised anion gap, due to pyroglutamic acid in the setting of malnutrition and chronic ingestion of acetaminophen.

Severe Anion Gap Metabolic Acidosis From Acetaminophen Use Secondary to 5-Oxoproline (Pyroglutamic Acid) Accumulation

2012 ◽  
Vol 344 (6) ◽  
pp. 501-504 ◽  
Author(s):  
Ladan Zand ◽  
Angela Muriithi ◽  
Eddie L. Greene ◽  
Qi Qian ◽  
Ziad M. El-Zoghby ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Pyroglutamic Acid ◽  
Anion Gap ◽  
Acid Accumulation

scholarly journals High anion gap metabolic acidosis secondary to pyroglutamic aciduria (5-oxoprolinuria): association with prescription drugs and malnutrition

2007 ◽  
Vol 44 (4) ◽  
pp. 406-409 ◽  
Author(s):  
G Brooker ◽  
J Jeffery ◽  
T Nataraj ◽  
M Sair ◽  
R Ayling
Keyword(s):  
Metabolic Acidosis ◽  
Prescription Drugs ◽  
Antibiotic Prescription ◽  
Pyroglutamic Acid ◽  
Metabolic Disturbance ◽  
Anion Gap ◽  
Uneventful Recovery ◽  
Hospital Treatment ◽  
Compromised Patients ◽  
Pyroglutamic Aciduria

Two cases of High Anion Gap Metabolic Acidosis (HAGMA) due to pyroglutamic acid (5-oxoproline) are described. In both cases the HAGMA developed during an episode of hospital treatment, in conjunction with paracetamol and antibiotic prescription, and the surviving patient made an uneventful recovery after the drugs were withdrawn. Clinicians need to be aware of this cause for metabolic acidosis because it may be a more common metabolic disturbance in compromised patients than would be expected, and the discontinuation of drugs implicated in the aetiology is therapeutic.

scholarly journals Acquired pyroglutamic acidaemia in a critically ill patient with chronic paracetamol use: A case report

2022 ◽  
Vol 10 ◽  
pp. 2050313X2110685
Author(s):  
Lee Connolly ◽  
Ed Briggs
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Metabolic Acidosis ◽  
Critically Ill ◽  
Care Setting ◽  
Pyroglutamic Acid ◽  
Anion Gap ◽  
Critically Ill Patient ◽  
Glutathione Metabolism ◽  
Patient Morbidity

Pyroglutamic acid is an endogenous organic acid and a metabolite in the γ-glutamyl cycle, involved in glutathione metabolism. Accumulation of pyroglutamic acid is a rare cause of high anion gap metabolic acidosis. There are multiple risk factors for pyroglutamic acid accumulation, such as chronic paracetamol use and sepsis. In this case report, we discuss how we came to this diagnosis, how it was subsequently managed and why it is an important consideration for critically ill patients with risk factors who are likely to end up in an intensive care setting. Pyroglutamic acid recognition and treatment could benefit patients in the critically ill population as pyroglutamic acid is a rare cause of high anion gap metabolic acidosis, which is likely under-recognised and easily treated. Inappropriate management of metabolic disorders can contribute to patient morbidity and mortality. Therefore, the recognition and appropriate management of pyroglutamic acidaemia could benefit patients with risk factors for its development in a critical care setting.

scholarly journals Increased Anion Gap Metabolic Acidosis as a Result of 5-Oxoproline (Pyroglutamic Acid): A Role for Acetaminophen

2006 ◽  
Vol 1 (3) ◽  
pp. 441-447 ◽  
Author(s):  
Andrew Z. Fenves ◽  
Haskell M. Kirkpatrick ◽  
Viralkumar V. Patel ◽  
Lawrence Sweetman ◽  
Michael Emmett
Keyword(s):  
Metabolic Acidosis ◽  
Pyroglutamic Acid ◽  
Anion Gap

scholarly journals Increased Anion Gap Metabolic Acidosis as a Result of 5- Oxoproline (Pyroglutamic Acid) in Pregnancy: A Case Report

2014 ◽  
Vol 7 (2) ◽  
pp. 47-49
Author(s):  
S Sathiyathasan ◽  
K Jeyanthan ◽  
H Soper ◽  
R Hamid
Keyword(s):  
Metabolic Acidosis ◽  
Pyroglutamic Acid ◽  
Anion Gap ◽  
Synthetase Activity ◽  
Serum Samples ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Obstetrics And Gynaecology ◽  
History Of ◽  
Urine And Serum

Accumulation of 5- Oxoproline (pyroglutamic acid) is a rare cause of severe, high anion gap metabolic acidosis in adults. A 21 year old lady presented at 39 weeks gestation in her first pregnancy with 2 weeks history of shortness of breath. Arterial blood gas showed metabolic acidosis. Urine and serum samples were taken which showed an increase in the serum level of 5- Oxoproline -creatinine ratio indicating pyroglutamic metabolic acidosis. Metabolic acidosis that is caused by 5- oxoproline results from disruption of the gamma glutamyl cycle. Glutamile synthetase (GS) deficiency is an autosomol recessive disorder. With GS deficiency, reduced glutathione levels increases gamma glutamile synthetase activity, and the resulting gamma - glutamile cystine levels are converted to 5-oxoproline.Suspicion for 5-oxoproline-associated high anion gap metabolic acidosis should be made when the cause of high anion gap metabolic acidosis remains poorly defined. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11144   Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 47-49

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