-transparent.png){kind=logo}
BACKGROUND Profound metabolic acidosis in critically ill adults sometimes remains unexplained despite extensive evaluation. METHODS A 58-year-old female presented in a confused state to the emergency department; she had been confused for several days. Laboratory evaluation revealed a high anion gap metabolic acidosis and modestly elevated acetaminophen level. Lactic acid was only modestly elevated. There was no evidence of ketoacids, salicylate, methanol, or ethylene glycol. A urine sample submitted on day 1 of hospitalization revealed a markedly elevated level of 5-oxoproline. CONCLUSIONS Originally described in children with an inherited defect of glutathione synthetase, 5-oxoproline is an unusual cause of metabolic acidosis. More recently this disturbance has been recognized in critically ill adults without a recognized inherited metabolic disorder. In most of these cases there has been the concomitant use of acetaminophen. Any causal relationship between acetaminophen and this disturbance is speculative. CONCLUSIONS In critically ill adults with unexplained metabolic acidosis, 5-Oxoproline should be considered in the differential.
Michael J Hodgman, and
James F Horn, and
Christine M Stork, and
Jeanna M Marraffa, and
Michael G Holland, and
Richard Cantor, and
Patti M Carmel
July 2001,
Acta paediatrica (Oslo, Norway : 1992),
Michael J Hodgman, and
James F Horn, and
Christine M Stork, and
Jeanna M Marraffa, and
Michael G Holland, and
Richard Cantor, and
Patti M Carmel
January 1991,
The Journal of pediatrics,
Michael J Hodgman, and
James F Horn, and
Christine M Stork, and
Jeanna M Marraffa, and
Michael G Holland, and
Richard Cantor, and
Patti M Carmel
July 2019,
Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine,
Michael J Hodgman, and
James F Horn, and
Christine M Stork, and
Jeanna M Marraffa, and
Michael G Holland, and
Richard Cantor, and
Patti M Carmel
July 1964,
Anaesthesia,
Michael J Hodgman, and
James F Horn, and
Christine M Stork, and
Jeanna M Marraffa, and
Michael G Holland, and
Richard Cantor, and
Patti M Carmel
February 1998,
Clinical chemistry,
Michael J Hodgman, and
James F Horn, and
Christine M Stork, and
Jeanna M Marraffa, and
Michael G Holland, and
Richard Cantor, and
Patti M Carmel
September 2010,
CJEM,
Michael J Hodgman, and
James F Horn, and
Christine M Stork, and
Jeanna M Marraffa, and
Michael G Holland, and
Richard Cantor, and
Patti M Carmel
March 2012,
British journal of clinical pharmacology,
Michael J Hodgman, and
James F Horn, and
Christine M Stork, and
Jeanna M Marraffa, and
Michael G Holland, and
Richard Cantor, and
Patti M Carmel
February 1963,
JAMA,
Michael J Hodgman, and
James F Horn, and
Christine M Stork, and
Jeanna M Marraffa, and
Michael G Holland, and
Richard Cantor, and
Patti M Carmel
June 2016,
Journal of medical case reports,
Michael J Hodgman, and
James F Horn, and
Christine M Stork, and
Jeanna M Marraffa, and
Michael G Holland, and
Richard Cantor, and
Patti M Carmel
July 2005,
American journal of kidney diseases : the official journal of the National Kidney Foundation,
