Metabolic Acidosis Due To Pyroglutamic Acid

Abstract

Metabolic acidosis is a common clinical disturbance due to increased plasma acidity caused by a primary decrease in serum HCO3- concentration. It is classified as normal or high anion gap metabolic acidosis. High anion gap metabolic acidosis can result from either a decrease in unmeasured cations (K+, Ca2+, Mg2+) or an increase in unmeasured anions (PO43−, albumin). However, other anions such as lactic acid or keto acids may cause this acid-base disorder. It can also result from renal failure and intoxication (salicylate, methanol, ethylene glycol), or more rarely, from massive rhabdomyolysis and pyroglutamic (5-oxoproline) acidemia. Acidemia due to pyroglutamic acid should be considered when no other aetiology is found. High anion gap metabolic acidosis is diagnosed in children with inherited defects in enzymes of the γ-glutamyl cycle. In adults, this disorder from pyroglutamic acid has been described in association with chronic acetaminophen misuse. We report a case of pyroglutamic acidosis in a woman with acute misuse of acetaminophen concurrent with chronic use.LEARNING POINTParacetamol is an easily available drug with potentially harmful consequences.Accumulation of pyroglutamic acid (5-oxoproline) may be a cause of high anion gap metabolic acidosis.Reporting cases of 5-oxoprolinemia acidosis contributes to better understanding of the condition.

Therapeutic Effect of Buyang Huanwu Decoction on the Gut Microbiota and Hippocampal Metabolism in a Rat Model of Cerebral Ischemia

“…Pyroglutamic acid can be cleaved by 5-oxoprolinase to produce glutamate and regulate the concentration of glutamate in the γ-glutamyl cycle ( Niehaus et al., 2017 ). Excessive accumulation of pyroglutamate can lead to high anion gap metabolic acidosis ( Serpa et al., 2018 ) and can cause protein oxidation and the production of active substances in the brains of rats to damage the antioxidant defense of the brain and promote oxidative stress ( Pederzolli et al., 2007 ; Pederzolli et al., 2010 ). In addition, we found that the level of pyroglutamic acid was positively correlated with Candidatus_Stoquefichus (correlation coefficient=0.64, p <0.001) and negatively correlated with Lactobacillus (correlation coefficient=-0.49, p <0.05).…”

Recurrent Pyroglutamic Acidosis in the Context of Undiagnosed Liver Cirrhosis—A Case Report

“…3,4 The risk factors for the condition are shown in Table 1, and particular emphasis is placed on the chronic use of paracetamol at even therapeutic doses. 3,5,6 Understanding of the pathophysiology begins with the glutathione metabolism and the g-glutamyl cycleas shown in Figure 1. Glutathione is an antioxidant found in all our cells where it acts to neutralise endogenous waste and xenobiotics.…”