Journal of Clinical Toxicology
Open Access

Brohan J

Publications

• Case Report
  Metabolic Acidosis with a Raised Anion Gap Associated with High 5-Oxoproline Levels; An Under-Recognized Cause for Metabolic Acidosis in Intensive Care
  Author(s): Brohan J, Donnelly M and Fitzpatrick GJBrohan J, Donnelly M and Fitzpatrick GJ
  
  Metabolic acidosis is a common problem in ICU patients. Frequent causes of metabolic acidosis with a raised anion gap include lactic acidosis and ketoacidosis. In recent years high anion gap acidosis due to acquired 5- oxoprolinuria has been reported in association with chronic paracetamol use 1. There have been occasional reports of acidosis due to 5-oxoproline in an ICU setting 2 but to date there does not seem to be a general awareness of this phenomonen. 5-oxoproline is an amino acid derivative within the γ-glutamyl cycle within the liver, When gluathione stores are depleted γ-glutamycycteine synthase activity increases in an attempt to replenish the glutathione stores. However in the process excess glutamylcycteine is produced which is then converted into 5-oxoproline which can accumulate and cause a metabolic acidosis. We present a case series of unexplained high ani.. View More»
  DOI: 10.4172/2161-0495.1000220

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