Department of Nephrology, Dialysis, and Transplantation, Bicêtre University Hospital, APHP, Paris Saclay University, 78 rue du Général Leclerc, Le Kremlin-Bicêtre, 94270, France.
Department of Infectious Diseases, Bicêtre University Hospital, APHP, Le Kremlin-Bicêtre, France.
BMC Nephrol. 2024 Aug 13;25(1):260. doi: 10.1186/s12882-024-03678-9.
Pyroglutamic acidosis is a rare cause of high anion gap metabolic acidosis. Most cases of paracetamol related pyroglutamic acidosis are described in malnourished women and patients with kidney/liver failure, alcohol use or severe sepsis. In this report, we describe how pyroglutamic acidosis could be related to the use of chronic therapeutic paracetamol with only malnutrition as an associated risk factor.
We report a case of a 67-year-old male patient developing a pyroglutamic acidosis. The patient was initially admitted to hospital for infectious osteoarthritis and developed a metabolic acidosis during his hospital stay. Analgesics included daily therapeutic doses of paracetamol. What makes our case unusual is that our malnourished male patient did not have renal or hepatic failure. The diagnosis of paracetamol related pyroglutamic acidosis was made after ruling out the main causes of metabolic acidosis. It was further confirmed by urine organic acids measurement showing a markedly elevated level of pyroglutamic aciduria. Paracetamol was discontinued allowing a prompt correction of the anion gap.
This case is a representative of pyroglutamic acidosis related to chronic therapeutic paracetamol with only malnutrition as an associated risk factor. Physicians should be aware of such unusual cause of metabolic acidosis, which may be more common than expected in hospitalized patients. A high clinical suspicion is needed when urine organic acids analysis is not available.
焦谷氨酸酸中毒是一种罕见的高阴离子间隙代谢性酸中毒的原因。大多数与对乙酰氨基酚相关的焦谷氨酸酸中毒病例发生在营养不良的女性和有肝/肾功能衰竭、酗酒或严重败血症的患者中。在本报告中，我们描述了焦谷氨酸酸中毒如何与仅存在营养不良这一相关风险因素的慢性治疗性对乙酰氨基酚的使用有关。
我们报告了一例 67 岁男性患者发生焦谷氨酸酸中毒的情况。该患者最初因感染性骨关节炎住院，并在住院期间发生代谢性酸中毒。使用的镇痛药包括每日治疗剂量的对乙酰氨基酚。使我们的病例不同寻常的是，我们营养不良的男性患者没有出现肾或肝衰竭。在排除代谢性酸中毒的主要原因后，诊断为与对乙酰氨基酚相关的焦谷氨酸酸中毒。尿液有机酸测量进一步证实了这一点，显示焦谷氨酸酸尿症水平显著升高。停用对乙酰氨基酚后，阴离子间隙迅速得到纠正。
本病例是一例与慢性治疗性对乙酰氨基酚相关的、仅存在营养不良这一相关风险因素的焦谷氨酸酸中毒的代表。医生应该意识到这种不常见的代谢性酸中毒的原因可能比预期的在住院患者中更为常见。当尿液有机酸分析不可用时，需要高度的临床怀疑。
