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Profound metabolic acidosis from pyroglutamic acidemia: an underappreciated cause of high anion gap metabolic acidosis

Published online by Cambridge University Press:  21 May 2015

Thomas J. Green ,
Jan Jaap Bijlsma  and
David D. Sweet
Thomas J. Green*
Affiliation:
Department of Emergency Medicine, University of British Columbia, Vancouver, BC
Jan Jaap Bijlsma
Affiliation:
Department of Emergency Medicine, University of British Columbia, Vancouver, BC
David D. Sweet
Affiliation:
Department of Emergency Medicine, University of British Columbia, Vancouver, BC Department of Medicine, University of British Columbia, Vancouver, BC Division of Critical Care Medicine, Vancouver General Hospital, Vancouver, BC
*
Department of Emergency Medicine, Vancouver General Hospital, 910 West 10th Ave., ground floor, JPPN, Vancouver BC V5Z 4E3; tomgreen@interchange.ubc.ca

Abstract

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The workup of the emergency patient with a raised anion gap metabolic acidosis includes assessment of the components of “MUDPILES” (methanol; uremia; diabetic ketoacidosis; paraldehyde; isoniazid, iron or inborn errors of metabolism; lactic acid; ethylene glycol; salicylates). This approach is usually sufficient for the majority of cases in the emergency department; however, there are many other etiologies not addressed in this mnemonic. Organic acids including 5-oxoproline (pyroglutamic acid) are rare but important causes of anion gap metabolic acidosis. We present the case of a patient with profound metabolic acidosis with raised anion gap, due to pyroglutamic acid in the setting of malnutrition and chronic ingestion of acetaminophen.

Keywords

pyroglutamic acid5-oxoprolinemetabolic acidosisacetaminophenmalnutritioncase report
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 5 , September 2010 , pp. 449 - 452
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

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