Nursing Case Study Essay

Words: 306
Pages: 2

A sixty-one-year-old woman with a history of type 2 DM on Metformin, CHF, hypothyroidism, depression, gastric bypass, chronic back pain on acetaminophen-oxycodone presented to the ED on account of poor oral intake, altered mental status and shortness of breath of a few days duration. Physical examination was significant for hypotension, tachypnea, dry oral mucosa, disorientation and Kussmaul breathing. Additional neurologic, respiratory and cardiac examinations were unremarkable. Laboratory data was remarkable for creatinine 5.64 mg/dl (Normal: 0.6-1.3 mg/dl), BUN 61 mg/dl (Normal: 7-25 mg/dl), glucose 87 mg/dl (Normal: 70-99 mg/dl), lactic acid 2.0 meq/L (Normal: 0.5-2.2 meq/L), anion gap >30 meq/L (Normal 4-12 meq/L) and osmolal gap of 9 mOsm/kg (Normal: <62). …show more content…
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