pyroglutamic acidosis

• related: Nephrology
• tags: #nephrology

The most likely diagnosis is pyroglutamic acidosis. Pyroglutamic acidosis, which presents with mental status changes and an increased anion gap, occurs in selected patients receiving therapeutic doses of acetaminophen on a chronic basis. Susceptible patients are those with critical illness, poor nutrition, liver disease, or chronic kidney disease, as well as those on a strict vegetarian diet. In this context, acetaminophen leads to depletion of glutathione, altering the γ-glutamyl cycle to overproduce pyroglutamic acid (also known as 5-oxoproline). Diagnosis can be confirmed by measuring urine levels of pyroglutamic acid.

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• anion gap metabolic acidosis
  • Paracetamol/acetaminophen, paraldehyde, pyroglutamic acidosis, polyethylene glycol (miralax, metabolizes to lactic acid; versed, in the preparation, in neuro icu), propofol infusion syndrome can lead to elevated lactic acidosis, propofol infusion syndrome is associated with high dose continuous infusion: Brugada syndrome