PT  - JOURNAL ARTICLE
AU  - Robert W Hunter
AU  - Cate Lawson
AU  - Evangelia Galitsiou
AU  - Fiona Gifford
AU  - John J Neary
TI  - Pyroglutamic acidosis in association with therapeutic paracetamol use
AID  - 10.7861/clinmedicine.16-6-524
DP  - 2016 Dec 01
TA  - Clinical Medicine
PG  - 524--529
VI  - 16
IP  - 6
4099  - http://www.rcpjournals.org/content/16/6/524.short
4100  - http://www.rcpjournals.org/content/16/6/524.full
SO  - Clin Med2016 Dec 01; 16
AB  - Long-term use of paracetamol (at therapeutic doses) can cause the accumulation of endogenous organic pyroglutamate, resulting in metabolic acidosis with an elevated anion gap. This occurs in the presence of malnutrition, infection, antibiotic use, renal failure and pregnancy. Given the prevalence of these risk factors, this condition is thought to be relatively common in a hospitalised population but is probably significantly underdiagnosed. Prompt recognition is essential because the condition is entirely reversible if the causative agents are withdrawn.Here we describe five cases of pyroglutamic acidosis that we have encountered in a tertiary referral hospital. Together they illustrate the common clinical risk factors and the excellent prognosis, once a diagnosis is made. We describe how a rudimentary acid-base analysis (calculation of the anion gap) usually leads to the diagnosis but how a more nuanced approach may be required in the presence of mixed acid-base disorders.