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 Pneumocystis and SARS-CoV-2 Co-Infection: A Case Report and Review of an Emerging Diagnostic Dilemma

2020 ◽  
Author(s):  
Carlos Rubiano ◽  
Kathleen Tompkins ◽  
Subhashini A Sellers ◽  
Brian Bramson ◽  
Joseph Eron ◽  
...  
Keyword(s):  
Case Report ◽  
Critically Ill ◽  
Therapeutic Strategies ◽  
Pneumocystis Jirovecii ◽  
Critically Ill Patient ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Diagnostic Dilemma

Abstract We present a case of a critically ill patient with COVID-19 found to have AIDS and Pneumocystis jirovecii pneumonia (PCP). COVID-19 and PCP co-occurrence is increasingly reported and may complicate diagnostic and therapeutic strategies. Patients with severe COVID-19 should be screened for underlying immunocompromise and coinfections should be considered.

scholarly journals Nonepileptic Myoclonus in COVID-19: Case Report

2021 ◽  
pp. 194187442110043
Author(s):  
Henly Hewan ◽  
Annie Yang ◽  
Aparna Vaddiparti ◽  
Benison Keung
Keyword(s):  
Case Report ◽  
Critically Ill ◽  
Recovery Phase ◽  
Critically Ill Patient ◽  
High Dose ◽  
The Novel ◽  
Neurological Manifestations ◽  
Immune Mediated ◽  
Novel Coronavirus ◽  
Post Infectious

In late 2019, the novel coronavirus, SARS-CoV-2, and the disease it causes, COVID-19, was identified. Since then many different neurological manifestations of COVID-19 have been well reported. Movement abnormalities have been rarely described. We report here a critically ill patient with COVID-19 who developed generalized myoclonus during the recovery phase of the infection. Myoclonus was associated with cyclical fevers and decreased alertness. Movements were refractory to conventional anti-epileptic therapies. There was concern that myoclonus could be part of a post-infectious immune-mediated syndrome. The patient improved fully with a 4-day course of high-dose steroids. Our experience highlights a rare, generalized myoclonus syndrome associated with COVID-19 that may be immune-mediated and is responsive to treatment.

The ART of Antiretroviral Therapy in Critically Ill Patients With HIV

2018 ◽  
Vol 34 (11-12) ◽  
pp. 897-909 ◽  
Author(s):  
Tyler Finocchio ◽  
William Coolidge ◽  
Thomas Johnson
Keyword(s):  
Intensive Care ◽  
Antiretroviral Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critically Ill Patient ◽  
Intensive Care Setting ◽  
Antiretroviral Medications ◽  
Immunodeficiency Virus ◽  
Inflammatory Syndrome

The management of patients with human immunodeficiency virus (HIV) can be a complicated specialty within itself, made even more complex when there are so many unanswered questions regarding the care of critically ill patients with HIV. The lack of consensus on the use of antiretroviral medications in the critically ill patient population has contributed to an ongoing clinical debate among intensivists. This review focuses on the pharmacological complications of antiretroviral therapy (ART) in the intensive care setting, specifically the initiation of ART in patients newly diagnosed with HIV, immune reconstitution inflammatory syndrome (IRIS), continuation of ART in those who were on a complete regimen prior to intensive care unit admission, barriers of drug delivery alternatives, and drug-drug interactions.

Is Pseudo-Cushing's Syndrome in a Critically Ill Patient "Pseudo"? Hypothesis and Supportive Case Report

2007 ◽  
Vol 13 (2) ◽  
pp. 153-158 ◽  
Author(s):  
David Kem ◽  
Jordan Metcalf ◽  
Ana Cornea ◽  
Monica Dunnam ◽  
Alice Engelbrecht ◽  
...  
Keyword(s):  
Case Report ◽  
Critically Ill ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Critically Ill Patient

scholarly journals Anion gap‐opening metabolic acidosis and urinary findings in the early diagnosis of ethylene glycol poisoning: A case report

2022 ◽  
Vol 10 (1) ◽  
Author(s):  
Kentaro Ukita ◽  
Kanako Otomune ◽  
Ryo Fujimoto ◽  
Kanako Hasegawa ◽  
Koichi Izumikawa ◽  
...  
Keyword(s):  
Case Report ◽  
Metabolic Acidosis ◽  
Early Diagnosis ◽  
Ethylene Glycol ◽  
Anion Gap ◽  
Ethylene Glycol Poisoning ◽  
Gap Opening

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 A Case Report of COVID-19 in New Orleans, Louisiana: Highlighting the Complexities of Prognostication in a Critically Ill Patient

2020 ◽  
Vol 1 (1) ◽  
pp. 227-231 ◽  
Author(s):  
Zachary I. Lerner ◽  
Rebecca V. Burke ◽  
Jonathan McCall ◽  
Alexandra Leigh ◽  
Marcia Glass
Keyword(s):  
Case Report ◽  
New Orleans ◽  
Critically Ill ◽  
Critically Ill Patient

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.

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