Metabolic Acidosis Due To Pyroglutamic Acid

Authors

• Maria João Raposo Linhares Serpa Internal Medicine Department, Hospital Beatriz Ângelo, Loures, Portugal
• Luís Falcão Nephrology Department, Hospital Beatriz Ângelo, Loures, Portugal
• Susana Franco Internal Medicine Department, Hospital Beatriz Ângelo, Loures, Portugal
• Diana Repolho Internal Medicine Department, Hospital Beatriz Ângelo, Loures, Portugal
• Nuno Ribeiro Ferreira Internal Medicine Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal

mariajoaoserpa10@gmail.com

Keywords

Abstract

Metabolic acidosis is a common clinical disturbance due to increased plasma acidity caused by a primary decrease in serum HCO3- concentration. It is classified as normal or high anion gap metabolic acidosis. High anion gap metabolic acidosis can result from either a decrease in unmeasured cations (K⁺, Ca2⁺, Mg2⁺) or an increase in unmeasured anions (PO₄^3-, albumin). However, other anions such as lactic acid or keto acids may cause this acid-base disorder. It can also result from renal failure and intoxication (salicylate, methanol, ethylene glycol), or more rarely, from massive rhabdomyolysis and pyroglutamic (5-oxoproline) acidemia. Acidemia due to pyroglutamic acid should be considered when no other aetiology is found. High anion gap metabolic acidosis is diagnosed in children with inherited defects in enzymes of the ?-glutamyl cycle. In adults, this disorder from pyroglutamic acid has been described in association with chronic acetaminophen misuse. We report a case of pyroglutamic acidosis in a woman with acute misuse of acetaminophen concurrent with chronic use. .