She improved on volume resuscitation, bicarbonate drip and supportive measures. She was subsequently discharged home with instruction to discontinue all acetaminophen containing medication. Her allergy list was updated to reflect acetaminophen intolerance.
Pyroglutamic acidosis or 5 oxoprolinuria is an established but often underdiagnosed cause of high anion gap metabolic acidosis (HAGMA). Pyroglutamic acidosis in adults results from an acquired deficiency of enzymes in the gamma glutamyl synthesis pathway often in association with chronic acetaminophen use. Other risk factors in the presence of acetaminophen use include malnutrition, renal failure, hepatic dysfunction, sepsis and certain antibiotics such as