Paracetamol
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Pyroglutamic acidosis: case report An 84-year-old woman developed pyroglutamic acidosis while receiving treatment with paracetamol [route and indication not stated]. The woman presented with one day history of confusion and distressing breathlessness. Her regular medications included paracetamol 1g four times daily along with other drugs. Examinations showed distress with classic deep, rapid Kussmaul respiration at respiratory rate of 22 breaths/minute, BP of 142/60mm Hg, pulse rate of 122 beats/minute and body temperature of 37.3°C. She was also disorientated with a 4AT delirium score of 8 out of 12. Mild generalised tenderness in the abdomen was also noted. At admission, lab tests showed pH of 7.11, partial pressure of carbon dioxide of 2.6kPa, bicarbonate of 9.1 mmol/L, lactate of 1.3 mmol/L, ketones of 2.1 mmol/L, blood glucose of 8.1 mmol/L, base excess of –23.3 mmol/L, acute kidney injury, total white cell count of 21 × 109/L with a neutrophilia, haemoglobin of 93 g/L and C- reactive protein of 128.93 mg/L. The woman was emphatically treated with levofloxacin and gentamicin along with fluid resuscitation. She was diagnosed with pyroglutamic acidosis secondary to paracetamol. Paracetamol was discontinued, and she was treated with fluid resuscitation and acetylcysteine. Within a week, she improved. On the day 8 of admission, she was discharged. After discharge, urinary pyroglutamate level was 800 µg/mg of creatinine. Trevor-Jones E, et al. Lessons of the month: Pyroglutamic acidosis: long-term paracetamol and a high anion gap. Clinical Medicine (London, England) 20: 522-523, No. 5, 803506880 Sep 2020. Available from: URL: http://doi.org/10.7861/clinmed.2020-0363
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Reactions 17 Oct 2020 No. 1826
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