High Anion Gap Metabolic Acidosis as a Result of 5-Oxoproline
High anion gap metabolic acidosis is a common acid–base disorder encountered in hospitalized patients and more so in the intensive care unit. The most common causes are accumulation of lactate, ketones, and urea and ingestion of certain toxins. In the absence of these, lesser-known etiologies such a...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-07-01
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| Series: | Indian Journal of Medical Specialities |
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| Online Access: | https://journals.lww.com/10.4103/injms.injms_8_22 |
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| author | Suvika Patel Falguni Parikh Niranjan Kulkarni |
| author_facet | Suvika Patel Falguni Parikh Niranjan Kulkarni |
| author_sort | Suvika Patel |
| collection | DOAJ |
| description | High anion gap metabolic acidosis is a common acid–base disorder encountered in hospitalized patients and more so in the intensive care unit. The most common causes are accumulation of lactate, ketones, and urea and ingestion of certain toxins. In the absence of these, lesser-known etiologies such as accumulation of D-lactate or pyroglutamic acid (PGA) should be suspected. PGA (5-oxoproline) is an endogenous organic acid that can accumulate in serum to cause anionic gap metabolic acidosis. This can occur with inherited defects in enzymes that participate in the y-glutamyl cycle or can be acquired in association with therapeutic paracetamol use, malnutrition, sepsis, antibiotics, and renal impairment. Our case illustrates that prompt recognition of this entity and discontinuation of offending agents such as paracetamol result in rapid recovery, thus reducing the hospital stay. |
| format | Article |
| id | doaj-art-89acb23e8ea8408d84e20e2d20d73e07 |
| institution | Kabale University |
| issn | 0976-2884 0976-2892 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Medical Specialities |
| spelling | doaj-art-89acb23e8ea8408d84e20e2d20d73e072025-08-25T08:38:24ZengWolters Kluwer Medknow PublicationsIndian Journal of Medical Specialities0976-28840976-28922022-07-0113319820010.4103/injms.injms_8_22High Anion Gap Metabolic Acidosis as a Result of 5-OxoprolineSuvika PatelFalguni ParikhNiranjan KulkarniHigh anion gap metabolic acidosis is a common acid–base disorder encountered in hospitalized patients and more so in the intensive care unit. The most common causes are accumulation of lactate, ketones, and urea and ingestion of certain toxins. In the absence of these, lesser-known etiologies such as accumulation of D-lactate or pyroglutamic acid (PGA) should be suspected. PGA (5-oxoproline) is an endogenous organic acid that can accumulate in serum to cause anionic gap metabolic acidosis. This can occur with inherited defects in enzymes that participate in the y-glutamyl cycle or can be acquired in association with therapeutic paracetamol use, malnutrition, sepsis, antibiotics, and renal impairment. Our case illustrates that prompt recognition of this entity and discontinuation of offending agents such as paracetamol result in rapid recovery, thus reducing the hospital stay.https://journals.lww.com/10.4103/injms.injms_8_22high anion gap metabolic acidosisparacetamolpyroglutamic acidosisrenal impairment |
| spellingShingle | Suvika Patel Falguni Parikh Niranjan Kulkarni High Anion Gap Metabolic Acidosis as a Result of 5-Oxoproline Indian Journal of Medical Specialities high anion gap metabolic acidosis paracetamol pyroglutamic acidosis renal impairment |
| title | High Anion Gap Metabolic Acidosis as a Result of 5-Oxoproline |
| title_full | High Anion Gap Metabolic Acidosis as a Result of 5-Oxoproline |
| title_fullStr | High Anion Gap Metabolic Acidosis as a Result of 5-Oxoproline |
| title_full_unstemmed | High Anion Gap Metabolic Acidosis as a Result of 5-Oxoproline |
| title_short | High Anion Gap Metabolic Acidosis as a Result of 5-Oxoproline |
| title_sort | high anion gap metabolic acidosis as a result of 5 oxoproline |
| topic | high anion gap metabolic acidosis paracetamol pyroglutamic acidosis renal impairment |
| url | https://journals.lww.com/10.4103/injms.injms_8_22 |
| work_keys_str_mv | AT suvikapatel highaniongapmetabolicacidosisasaresultof5oxoproline AT falguniparikh highaniongapmetabolicacidosisasaresultof5oxoproline AT niranjankulkarni highaniongapmetabolicacidosisasaresultof5oxoproline |