Citation

Leung PSC, Tsui SH, Siu TS, Tam S. Hong Kong J. Emerg. Med. 2011; 18(4): 264-270.

Copyright

(Copyright © 2011, Medcom Limited)

DOI

10.1177/102490791101800414

PMID

unavailable

Abstract

5-oxoprolinuria is an uncommon and under-recognised cause of early high anion gap metabolic acidosis after paracetamol overdose. We reported a 30-year-old Indian woman with history of chronic alcoholism who ingested 150 g crushed paracetamol tablets for suicide 14 hours before attendance to the A&E Department. Initial arterial blood gas showed a high anion gap metabolic acidosis with respiratory compensation. Serum paracetamol level reached 5004 umol/L and a prolonged course of N-acetylcysteine was given. She was complicated by hepatotoxicity and 5-oxoprolinuria (with laboratory confirmation) which reverted after antidote administration. There were no neurological and hepatic sequelae. In case of massive overdose, pathways of drug metabolism are altered prior to the centrilobular hepatic necrosis. A metabolic intermediate of gamma-glutamyl cycle, 5-oxoproline, accumulates upon saturation of endogenous glutathione store. The specific antidote N-acetylcysteine is the only definitive treatment. Prolonged course of antidote may be required in cases of massive overdose and treatment should be individualised.

Language: en

Keywords

adult; human; female; alcoholism; case report; suicide attempt; Acetaminophen; drug overdose; glutathione; article; vomiting; drug intoxication; physical examination; intensive care unit; drowsiness; paracetamol; activated carbon; ingestion; confusion; drug blood level; antidote; neurologic disease; clinical examination; epigastric pain; QT prolongation; liver toxicity; acetylcysteine; bicarbonate; electrocardiogram; metabolic acidosis; laboratory test; toxicity testing; thorax radiography; sinus tachycardia; oxygen saturation; neurologic examination; liver disease; mass fragmentography; blood gas analysis; arterial gas; Drug toxicity; anion gap; kidney function test; Acidosis; Glutathione; 5 oxoprolinuria; pyroglutamic acid; Pyrrolidonecarboxylic Acid