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焦谷氨酸酸中毒——一种与对乙酰氨基酚使用相关的未被充分认识的病症。

Pyroglutamic Acidosis - An Underrecognised Entity Associated with Acetaminophen Use.

作者信息

Ng Wincy Wing-Sze, Tong Hok-Fung, Ng Wai-Yan, Yeung Joshua Ka-Ho, Young Joyce Kit-Yu, Woo Raymond Kam-Wing, Wong Maureen Mo-Lin

机构信息

Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong Special Administrative Region, China.

Department of Pathology, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Hong Kong Special Administrative Region, Kowloon, China.

出版信息

Rom J Anaesth Intensive Care. 2023 Apr 20;30(1):26-30. doi: 10.2478/rjaic-2023-0004. eCollection 2023 Apr.

DOI:10.2478/rjaic-2023-0004
PMID:37635852
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10448446/
Abstract

Pyroglutamic acidosis (PGA) is an underrecognized entity characterised by raised anion gap metabolic acidosis (RAGMA) and urinary hyper-excretion of pyroglutamic acid. It is frequently associated with chronic acetaminophen (APAP) ingestion. We report the case of a 73-year-old man with invasive pulmonary aspergillosis treated with voriconazole and APAP for analgesia with a cumulative dose of 160 g over 40 days. PGA was suspected as he developed severe RAGMA and common causes were excluded. Diagnosis was confirmed via urinary organic acid analysis which showed significant hyper-excretion of pyroglutamic acid. APAP was discontinued, and N-acetylcysteine (NAC) was administered. His RAGMA rapidly resolved following treatment.

摘要

焦谷氨酸酸中毒（PGA）是一种未被充分认识的病症，其特征为阴离子间隙代谢性酸中毒（RAGMA）升高和尿中焦谷氨酸排泄过多。它常与长期服用对乙酰氨基酚（APAP）有关。我们报告一例73岁男性侵袭性肺曲霉病患者，接受伏立康唑和APAP镇痛治疗，40天内累积剂量达160克。由于患者出现严重的RAGMA且排除了常见病因，故怀疑为PGA。通过尿有机酸分析确诊，结果显示焦谷氨酸排泄显著过多。停用APAP，并给予N-乙酰半胱氨酸（NAC）治疗。治疗后其RAGMA迅速缓解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9f42/10448446/a5d0af3d4c9c/j_rjaic-2023-0004_fig_001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9f42/10448446/a5d0af3d4c9c/j_rjaic-2023-0004_fig_001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9f42/10448446/a5d0af3d4c9c/j_rjaic-2023-0004_fig_001.jpg

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本文引用的文献

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Clin Chem. 2020 Apr 1;66(4):518-522. doi: 10.1093/clinchem/hvz035.
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Metabolomics Investigation of Voriconazole-Induced Hepatotoxicity in Mice.基于代谢组学研究伏立康唑诱导的小鼠肝毒性
Chem Res Toxicol. 2019 Sep 16;32(9):1840-1849. doi: 10.1021/acs.chemrestox.9b00176. Epub 2019 Aug 28.
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