RT Journal Article
SR Electronic
T1 Pyroglutamic acidosis in association with therapeutic paracetamol use
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 524
OP 529
DO 10.7861/clinmedicine.16-6-524
VO 16
IS 6
A1 Robert W Hunter
A1 Cate Lawson
A1 Evangelia Galitsiou
A1 Fiona Gifford
A1 John J Neary
YR 2016
UL http://www.rcpjournals.org/content/16/6/524.abstract
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 Prompt recognition is essential because the condition is entirely reversible if the causative agents are withdrawn.Here we describe five cases of pyroglutamic acidosis that we have encountered in a tertiary referral hospital.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.