Acquired 5-oxoprolinuria (Pyroglutamic acidaemia) as a cause of early high anion gap metabolic acidosis in acute massive paracetamol overdose

Hong Kong Journal of Emergency Medicine

Volumn 18, Issue 4, 2011, Pages 264-270

  Leung, P S C ^a   Tsui, S H ^a   Siu, T S ^a   Tam, S ^a  

^a QUEEN MARY HOSPITAL   (Hong Kong)

Author keywords

Acetaminophen; Acidosis; Drug toxicity; Glutathione; Pyrrolidonecarboxylic Acid

Indexed keywords

ACETYLCYSTEINE; ACTIVATED CARBON; ANTIDOTE; BICARBONATE; GLUTATHIONE; PARACETAMOL; PYROGLUTAMIC ACID;

5 OXOPROLINURIA; ADULT; ALCOHOLISM; ANION GAP; ARTERIAL GAS; ARTICLE; BLOOD GAS ANALYSIS; CASE REPORT; CLINICAL EXAMINATION; CONFUSION; DROWSINESS; DRUG BLOOD LEVEL; DRUG INTOXICATION; DRUG OVERDOSE; ELECTROCARDIOGRAM; EPIGASTRIC PAIN; FEMALE; HUMAN; INGESTION; INTENSIVE CARE UNIT; KIDNEY FUNCTION TEST; LABORATORY TEST; LIVER DISEASE; LIVER TOXICITY; MASS FRAGMENTOGRAPHY; METABOLIC ACIDOSIS; NEUROLOGIC DISEASE; NEUROLOGIC EXAMINATION; OXYGEN SATURATION; PHYSICAL EXAMINATION; QT PROLONGATION; SINUS TACHYCARDIA; SUICIDE ATTEMPT; THORAX RADIOGRAPHY; TOXICITY TESTING; VOMITING;

EID: 79961015613     PISSN: 10249079     EISSN: None     Source Type: Journal    
DOI: 10.1177/102490791101800414     Document Type: Article

References (20)

1. Pharmaceutical Service, Department of Health, The Government of the Hong Kong Special Administrative Region of the People's Republic of China. [cited 9 Dec 2010 & 18 Apr 2011]. Available from: http://www.psdh.gov.hk/eps/
2. Ghauri FY, McLean AE, Beales D, Wilson ID,Nicholson JK. Induction of 5-oxoprolinuria in the rat following chronic feeding with N-acetyl 4-aminophenol (paracetamol). Biochem Pharmacol 1993;46(5):953-7.
3. Lawrence DT, Bechtel LK, Charlton NP, Holstege CP.5-oxoproline-induced anion gap metabolic acidosis after an acute acetaminophen overdose. J Am Osteopath Assoc 2010;110(9):545-51.
4. Butera L, Feinfeld DA, Bhargava M. Sex differences in the subunits of glutathione-S-transferase iso-enzyme from rat and human kidney. Enzyme 1990;43(4):175-82.
5. Ookhtens M, Kaplowitz N. Role of the liver in interorgan homeostasis of glutathione and cyst(e)ine. Semin Liver Dis 1998;18(4):313-29.
6. Pitt JJ, Brown GK, Clift V, Christodoulou J. Atypical pyroglutamic aciduria: Possible role of paracetamol. J Inherit Metab Dis 1990;13(5):755-6.
7. Pitt JJ, Hauser S. Transient 5-oxoprolinuria and high anion gap metabolic acidosis: clinical and biochemical findings in eleven subjects. Clin Chem 1998;44(7): 1497-503.
8. Dempsey GA, Lyall HJ, Corke CF, Scheinkestel CD.Pyroglutamic acidemia: A cause of high anion gap metabolic acidosis. Crit Care Med 2000;28(6):1803-7.
9. Humphreys BD, Forman JP, Zandi-Nejad K, Bazari H,Seifter J, Magee CCx./x Acetaminophen-induced anion gap metabolic acidosis and 5-oxoprolinuria (pyroglutamic aciduria) acquired in hospital. Am J Kidney Dis 2005; 46(1):143-6.
10. Bonham JR, Rattenbury JM, Meeks A, Pollitt RJ Pyroglutamicaciduria from vigabatrin. Lancet 1989;1(8652):1452-3.
11. Croal BL, Glen AC, Kelly CJ, Logan RW. Transient Cc aciduria) with systemic acidosis in an adult receiving antibiotic therapy. Clin Chem 1998;44(2):336-40.
12. Jackson AA, Persaud C, Werkmeister G, McClelland IS, Badaloo A, Forrester T. Comparison of urinary 5-L-oxoproline (L-pyroglutamate) during normal pregnancy in women in England and Jamaica. Br J Nutr 1997;77(2):183-196.
13. Persaud C, Forrester T, Jackson AA. Urinary excretion of 5-L-oxoproline (pyroglutamic acid) is increased during recovery from severe childhood malnutrition and responds to supplemental glycine. J Nutr 1996;126(11): 2823-30.
14. Jackson AA, Persaud C, Meakins TS, Bundy R. Urinary excretion of 5-L-oxoproline (pyroglutamic acid) is increased in normal adults consuming vegetarian or low protein diets. J Nutr 1996;126(11):2813-22.
15. Mayatepek E. 5-Oxoprolinuria in patients with and without defects in the gamma-glutamyl cycle. Eur J Pediatr 1999;158(3):221-5.
16. Roth B, Woo O, Blanc P. Early metabolic acidosis and coma after acetaminophen ingestion. Ann Emerg Med 1999;33(4):452-6.
17. Zein JG, Wallace DJ, Kinasewitz G, Toubia N, Kakoulas C. Early anion gap metabolic acidosis in acetaminophen overdose. Am J Emerg Med 2010;28(7):798-802.
18. Morishita H, Nagaya S, Nakajima T, Kawase A, Ohya A, Sugiyama S, Pyroglutamic aciduria in propionyl CoA carboxylase deficiency. J Inherit Metab Dis 1984;7(3):139-40.
19. Betten DP, Cantrell FL, Thomas SC, Williams SR,Clark RF. A prospective evaluation of shortened course oral N-acetylcysteine for the treatment of acute acetaminophen poisoning. Ann Emerg Med 2007;50(3):272-9.
20. Smith SW, Howland MA, Hoffman RS, Nelson LS.Acetaminophen overdose with altered acetaminophen pharmacokinetics and hepatotoxicity associated with premature cessation of intravenous N-acetylcysteine therapy. Ann Pharmacother 2008;42(9):1333-9