Anion Gap Acidosis Associated with Acetaminophen
Authors: Steven H. Yale
Journal: Annals of Internal Medicine (2000)

Letters7 November 2000Anion Gap Acidosis Associated with AcetaminophenSteven H. Yale, MD and Joseph J. Mazza, MDSteven H. Yale, MDMarshfield Clinic; Marshfield, WI 54449 (Yale, Mazza)Search for more papers by this author and Joseph J. Mazza, MDMarshfield Clinic; Marshfield, WI 54449 (Yale, Mazza)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-133-9-200011070-00036 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Pyroglutamic aciduria (5-oxoprolinuria) is caused by a deficiency of gluthathione synthetase of 5-oxoprolinase. This disorder has been reported after the ingestion of therapeutic doses of acetaminophen and has been fatal (1). We report pyroglutamic aciduria developing after acetaminophen–oxycodone treatment.A previously healthy 44-year-old woman presented with a 1-month history of back pain treated with acetaminophen–oxycodone, one to two tablets every 6 hours. Evaluation revealed a muscle strain and a fruity smell on her breath. Notable laboratory values were a CO2 level of 15 mEq/L, anion gap of 25 mEq/L, β-hydroxybutyrate level of 5.3 mEq/L, lactate level of ...References1. Pitt JJ, Hauser S. Transient 5-oxoprolinuria and high anion gap metabolic acidosis: clinical and biochemical findings in eleven subjects. Clin Chem. 1998;44:1497-503. CrossrefMedlineGoogle Scholar2. Spielberg SP. In vitro assessment of pharmacogenetic susceptibility to toxic drug metabolites in humans. Fed Proc. 1984;43:2308-13. MedlineGoogle Scholar3. Spielberg SP. Acetaminophen toxicity in lymphocytes heterozygous for glutathione synthetase deficiency. Can J Physiol Pharmacol. 1985;63:468-71. CrossrefMedlineGoogle Scholar4. Creer MH, Lau BW, Jones JD, Chan KM. Pyroglutamic acidemia in an adult patient. Clin Chem. 1989;35:684-6. CrossrefMedlineGoogle Scholar5. Pitt JJ, Brown GK, Clift V, Christodoulou J. Atypical pyroglutamic aciduria: possible role of paracetamol. J Inherit Metab Dis. 1990;13:755-6. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Steven H. Yale, MD; Joseph J. Mazza, MDAffiliations: Marshfield Clinic; Marshfield, WI 54449 (Yale, Mazza) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byIatrogenic and Poison-Derived Acid Base DisordersAcidose métabolique à trou anionique élevé dans un contexte d’intoxication chronique au paracétamol (acétaminophène)Translational biomarkers of acetaminophen-induced acute liver injuryWhat is the clinical significance of 5-oxoproline (pyroglutamic acid) in high anion gap metabolic acidosis following paracetamol (acetaminophen) exposure?An Unusual Cause of High Anion Gap Metabolic AcidosisAcetaminophenSevere Anion Gap Metabolic Acidosis From Acetaminophen Use Secondary to 5-Oxoproline (Pyroglutamic Acid) AccumulationRecurrent anion gap metabolic acidosis in a woman with vertebral disc diseaseFour nephrology myths debunkedUnderstanding lactic acidosis in paracetamol (acetaminophen) poisoningAcid-Base Disorders Secondary to PoisoningParacetamol-induced 5-oxoprolinuira and high anion gap metabolic acidosis in a child on a ketogenic dietProfound metabolic acidosis and oxoprolinuria in an adultRecurrent High Anion Gap Metabolic Acidosis Secondary to 5-Oxoproline (Pyroglutamic Acid)Acetaminophen-Induced Anion Gap Metabolic Acidosis and 5-Oxoprolinuria (Pyroglutamic Aciduria) Acquired in Hospital 7 November 2000Volume 133, Issue 9Page: 752-753KeywordsAnionsCell metabolismGlutathioneIngestionLigasesMusclesResearch laboratoriesSalicylatesSmellUrine ePublished: 7 November 2000 Issue Published: 7 November 2000 Copyright & PermissionsCopyright © 2000 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...