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Adverse reactions

Michael Riste and George Trafford
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DOI: https://doi.org/10.7861/clinmedicine.19-4-357
Clin Med July 2019
Michael Riste
Heartlands Hospital, Birmingham, UK
Roles: Specialty registrar in infectious diseases and general internal medicine
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George Trafford
Heartlands Hospital, Birmingham, UK
Roles: Specialty registrar in infectious diseases and microbiology
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Editor – I read with interest ‘Lesson of the month 1: A rare adverse reaction between flucloxacillin and paracetamol’, published in March's Clinical Medicine, and write with a similar case seen recently in our institution, to further highlight this issue. In addition, although the diagnostic test of choice (urinary organic acids) was unavailable locally we were able to confirm the diagnosis by liaising with another hospital laboratory within our region.

An 80-year-old patient with left leg cellulitis and a non-drainable calf abscess, requiring a 3-week course of intravenous flucloxacillin, developed marked hypokalaemia and was found to have a severe, high anion-gap metabolic acidosis (pH 7.16, bicarbonate 7.4 mmol/L, base excess -22.4 mmol/L, serum anion gap 30 mmol/L), without acute kidney injury. Pyroglutamic acidosis was suspected and flucloxacillin and paracetamol were discontinued, and N-acetylcysteine was administered. The acidosis resolved over the course of several days. Urinary organic acid testing was performed at another hospital in the region, showing grossly increased levels of pyroglutamic acid, which had resolved when a repeat specimen was sent 9 days later.

  • © Royal College of Physicians 2019. All rights reserved.

Reference

    1. Osborne W
    , Chavda A, Katritsis G, Friedland JS. Lesson of the month 1: A rare adverse reaction between flucloxacillin and paracetamol. Clin Med 2019:19;127–8.
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Adverse reactions
Michael Riste, George Trafford
Clinical Medicine Jul 2019, 19 (4) 357; DOI: 10.7861/clinmedicine.19-4-357

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Adverse reactions
Michael Riste, George Trafford
Clinical Medicine Jul 2019, 19 (4) 357; DOI: 10.7861/clinmedicine.19-4-357
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