Spring A, Owens R, Fratita M, O’Dwyer M
St. Vincent’s University Hospital Intensive Care Department, Elm Park, Dublin 4
Ir Med J. 2019 Apr 11;112(4):918.
Case Pyroglutamic acidosis is an uncommonly diagnosed but important cause of a high anion gap metabolic acidosis. Our case report concerns an elderly male admitted to the Intensive Care Unit (ICU) following the acute onset of coma which developed during treatment of a prosthetic joint infection. A diagnosis of pyroglutamic acidosis was ultimately made and later confirmed with laboratory testing. Blood gas analysis revealed a profound high anion gap metabolic acidosis. Treatment Treatment included withdrawal of the precipitating medications, N-acetylcysteine and sodium bicarbonate. Discussion This case highlights an unusual cause of severe metabolic acidosis caused by commonly used medications and readily reversible if recognised. This is of particular relevance in elderly, frail patients as incorrect alternate diagnoses may result in decisions which incorrectly limit critical care therapies.
病例 焦谷氨酸酸中毒是一种诊断不常见但却是高阴离子间隙代谢性酸中毒的重要病因。我们的病例报告涉及一名老年男性，他在人工关节感染治疗期间急性昏迷发作后被收入重症监护病房（ICU）。最终诊断为焦谷氨酸酸中毒，后来经实验室检查得以证实。血气分析显示严重的高阴离子间隙代谢性酸中毒。治疗 治疗措施包括停用诱发药物、给予N - 乙酰半胱氨酸和碳酸氢钠。讨论 本病例突出了由常用药物引起的严重代谢性酸中毒的一种不寻常病因，若能识别则很容易逆转。这在老年体弱患者中尤为重要，因为错误的替代诊断可能导致做出错误限制重症监护治疗的决定。
