Pyroglutamic Acidosis – An Underrecognised Entity Associated with Acetaminophen Use
Wincy Wing-Sze Ng
Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative RegionChai Wan, China
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, Hok-Fung Tong
Department of Pathology, Princess Margaret Hospital, Hong Kong Special Administrative RegionKowloon, China
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, Wai-Yan Ng
Department of Pathology, Princess Margaret Hospital, Hong Kong Special Administrative RegionKowloon, China
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, Joshua Ka-Ho Yeung
Department of Medicine & Geriatrics/ICU, Caritas Medical Centre, Hong Kong Special Administrative RegionKowloon, China
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, Joyce Kit-Yu Young
Department of Medicine & Geriatrics/ICU, Caritas Medical Centre, Hong Kong Special Administrative RegionKowloon, China
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, Raymond Kam-Wing Woo
Department of Medicine & Geriatrics/ICU, Caritas Medical Centre, Hong Kong Special Administrative RegionKowloon, China
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and Maureen Mo-Lin Wong
Department of Medicine & Geriatrics/ICU, Caritas Medical Centre, Hong Kong Special Administrative RegionKowloon, China
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Apr 20, 2023
About this article
Article Category: Case Report
Published Online: Apr 20, 2023
Page range: 26 - 30
DOI: https://doi.org/10.2478/rjaic-2023-0004
Keywords
© 2023 Wincy Wing-Sze Ng et al., published by sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Figure 1.
Relevant laboratory studies on day of diagnosis
| Parameter | Result | Reference interval |
|---|---|---|
| Sodium, plasma (mmol/L) | 142 | 137– 44 mmol/L |
| Potassium, plasma (mmol/L) | 4.4 | 3.5–4.5 mmol/L |
| Chloride, plasma (mmol/L) | 107 | 98–107 mmol/L |
| Bicarbonate, plasma (mmol/L) | 5.8 (L) | 23–27 mmol/L |
| Anion gap |
29 (H) | 8–12 mmol/L |
| Albumin, plasma (g/L) | 25 (L) | 35–52 mmol/L |
| Total bilirubin, plasma (μmol/L) | 5 | <19 μmol/L |
| ALP, plasma (U/L) | 251 (H) | 43–105 U/L |
| ALT, plasma (U/L) | 11 | <53 U/L |
| Urea, plasma (mmol/L) | 4.9 | 3.1–7.8 mmol/L |
| Creatinine, plasma (μmol/L) | 176 (H) | 65–109 μmol/L |
| eGFR (CKD-EPI) (ml/min/1.73m2) | 32 | >90 ml/min/1.73m2 |
| Lactate, plasma (mmol/L) | 2.4 (H) | <2.2 mmol/L |
| Beta-hydroxybutyrate, plasma (mmol/L) | 2.92 (H) | ≤0.30 mmol/L |
| Osmolality, serum (mOsm/kg) | 294 | 274–295 mOsm/kg |
| Osmolal gap, plasma |
3 | <10 mOsm/kg |
| Random glucose, plasma (mmol/L) | 8.3 | - |
| Acetaminophen, serum (μmol/L) | 119 | Therapeutic range: 66–199 μmol/L |
| pH | 7.17 (L) | 7.35–7.45 |
| PaCO2 (kPa) | 1.73 | 4.66–6.00 kPa |
| PaO2 (kPa) | 12.4 | 10–13.33 kPa |
| Actual bicarbonate (mmol/L) | 4.7 (L) | 22–26 mmol/L |
| Base excess (mmol/L) | −21.7 (L) | –2.0–+2.0 mmol/L |
| Sodium, urine (mmol/L) | 93 | - |
| Potassium, urine (mmol/L) | 26 | - |
| Chloride, urine (mmol/L) | <20 | - |
| Urine anion gap |
>99 (H) | <10 mmol/L |
| Urine organic acids analysis by LC-MS/MS. | Significant hyper-excretion of pyroglutamic acid. | |