Kwon Danny, Seu Michelle, Barnes Sylvester
Department of Internal Medicine, Loyola University Medical Center, Maywood, USA.
Department of Neurology, Loyola University Medical Center, Maywood, USA.
Cureus. 2024 May 29;16(5):e61328. doi: 10.7759/cureus.61328. eCollection 2024 May.
A rare complication, 5-oxoproline-induced high anion gap metabolic acidosis (HAGMA) is associated with chronic acetaminophen use, predominantly reported in outpatient settings. However, its occurrence in hospitalized patients, particularly those with end-stage renal disease (ESRD), remains underreported. We present a case of a 74-year-old female with ESRD on hemodialysis who developed HAGMA highly suspicious for 5-oxoproline toxicity from acetaminophen usage following cardiac surgery. Despite a standard analgesic dose, the patient's renal impairment likely predisposed her to 5-oxoproline accumulation, resulting in severe metabolic acidosis. Discontinuation of acetaminophen led to the resolution of HAGMA, highlighting the importance of recognizing this rare but potentially life-threatening complication in the inpatient and critical care setting. This case suggests a potential interaction between acetaminophen metabolism and renal dysfunction in the pathogenesis of 5-oxoproline-induced HAGMA.
一种罕见的并发症，5-氧脯氨酸诱导的高阴离子间隙代谢性酸中毒（HAGMA）与长期使用对乙酰氨基酚有关，主要在门诊环境中报道。然而，其在住院患者中，特别是终末期肾病（ESRD）患者中的发生情况仍报告不足。我们报告一例74岁女性ESRD患者，在心脏手术后因使用对乙酰氨基酚而发生高度怀疑为5-氧脯氨酸毒性的HAGMA。尽管使用的是标准镇痛剂量，但患者的肾功能损害可能使其易发生5-氧脯氨酸蓄积，导致严重代谢性酸中毒。停用对乙酰氨基酚后HAGMA得到缓解，突出了在住院和重症监护环境中认识到这种罕见但可能危及生命的并发症的重要性。该病例提示在5-氧脯氨酸诱导的HAGMA发病机制中，对乙酰氨基酚代谢与肾功能不全之间可能存在相互作用。
