| Acetaminophen-induced anion gap metabolic acidosis and 5-oxoprolinuria (pyroglutamic aciduria) acquired in hospital. | |
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MedLine Citation:
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PMID: 15983968 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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A rare cause of high anion gap acidosis is 5-oxoproline (pyroglutamic acid), an organic acid intermediate of the gamma-glutamyl cycle. Acetaminophen and several other drugs have been implicated in the development of transient 5-oxoprolinemia in adults. We report the case of a patient with lymphoma who was admitted for salvage chemotherapy. The patient subsequently developed fever and neutropenia and was administered 20.8 g of acetaminophen during 10 days. During this time, anion gap increased from 14 to 30 mEq/L (14 to 30 mmol/L) and altered mental status developed. After usual causes of high anion gap acidosis were ruled out, a screen for urine organic acids showed 5-oxoproline levels elevated at 58-fold greater than normal values. Predisposing factors in this case included renal dysfunction and sepsis. Clinicians need to be aware of this unusual cause of anion gap acidosis because it may be more common than expected, early discontinuation of the offending agent is therapeutic, and administration of N -acetylcysteine could be beneficial. |
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Authors:
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Benjamin D Humphreys; John P Forman; Kambiz Zandi-Nejad; Hasan Bazari; Julian Seifter; Colm C Magee |
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Publication Detail:
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Type: Case Reports; Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: American journal of kidney diseases : the official journal of the National Kidney Foundation Volume: 46 ISSN: 1523-6838 ISO Abbreviation: Am. J. Kidney Dis. Publication Date: 2005 Jul |
Date Detail:
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Created Date: 2005-06-28 Completed Date: 2005-11-03 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8110075 Medline TA: Am J Kidney Dis Country: United States |
Other Details:
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Languages: eng Pagination: 143-6 Citation Subset: IM |
Affiliation:
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Department of Medicine, Renal Division, Brigham and Women's Hospital, Boston, MA, USA. bhumphreys@partners.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acetaminophen
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adverse effects*,
therapeutic use Acid-Base Equilibrium / drug effects* Acidosis / chemically induced, etiology* Adult Analgesics, Non-Narcotic / adverse effects*, therapeutic use Antineoplastic Combined Chemotherapy Protocols / adverse effects, therapeutic use Bicarbonates / blood, therapeutic use Candidiasis / etiology Chlorides / blood Cytarabine / administration & dosage Etoposide / administration & dosage Fatal Outcome Fever / drug therapy, etiology Humans Ifosfamide / administration & dosage, adverse effects Kidney Tubular Necrosis, Acute / chemically induced, complications*, drug therapy Lymphoma, Follicular / complications Lymphoma, Large B-Cell, Diffuse / complications, drug therapy Male Mesna / administration & dosage Neutropenia / complications Polycystic Kidney, Autosomal Dominant / complications Pyrrolidonecarboxylic Acid / urine* Salvage Therapy Systemic Inflammatory Response Syndrome / etiology |
| Grant Support | |
ID/Acronym/Agency:
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F32 DK069037-01/DK/NIDDK NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Analgesics, Non-Narcotic; 0/Bicarbonates; 0/Chlorides; 103-90-2/Acetaminophen; 147-94-4/Cytarabine; 19767-45-4/Mesna; 33419-42-0/Etoposide; 3778-73-2/Ifosfamide; 98-79-3/Pyrrolidonecarboxylic Acid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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