|Aspirin or Salicylates toxicity
|Ethylene glycol toxicity
|Renal Tubular Acidosis
Thin, weak, muscle aches
Extra strength Q2 she takes
Large anion gap Link to author
Pyroglutamic acidosis. Elevated pyroglutamic acid is an example of an endogenous acid. Seen in those who are already glutathione-depleted
- Acidosis due to glutathione depletion
- Pyroglutamic acid is produced from Gamma-glutamyl cysteine by the enzyme Gamma-glutamyl cyclotransferase
- When glutathione levels are low, the activity of Gamma-glutamyl cyclotransferase is increased, resulting pyroglutamic acid accumulation.
- Glutathione is acutely depleted by paracetamol and sepsis; it can also be chronically depleted in liver disease and malnutrition.
- Paracetamol ingestion, Severe sepsis
- Renal failure, Female gender
- Chronic alcoholism or Chronic liver failure of any cause
- Weird diet, or malnutrition in general
- Dysfunction of 5-oxoprolinase
- Flucloxacillin, Vigabatrin
- Netilmicin (but apparently not any other aminoglycosides)
- Inherited enzyme deficiency (known only from case reports)
- Gender-specific difference in enzyme activity (women seem more prone to this acidosis)
- Diminished 5-oxoproline clearance
- Acidotic Kussmaul's respiration
- May have sepsis
- ABG: Marked metabolic acidosis with a high anion gap.
- Lactate and ketones may be normal.
- Management comprises cessation of paracetamol/fluxcloxacillin and the administration of bicarbonate (and other electrolyte) supplements ± N-acetyl cysteine. Glutathione repletion (with N-acetylcysteine)
- Protection of satisfactory diuresis (5-oxoproline is cleared renally)
- Mixed acid-base disorders are often present and specialist input may be required to reach a complete diagnosis.
- Dialysis may be needed in some cases. Take senior advice.