Acetaminophen induced high anion gap metabolic acidosis: a potentially under-recognized consequence from a common medication

While metabolic acidosis is one of the most common complications in patients with chronic kidney disease (CKD), there are several uncommon etiologies that are challenging to diagnose. Here, we describe a patient on peritoneal dialysis who developed high anion gap metabolic acidosis secondary to acqu...

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Bibliographic Details
Published in:Pediatric nephrology (Berlin, West) West), 2025, Vol.40 (1), p.99-101
Main Authors: Gaur, Dhruv, Michalopulos, Michael G., Drake, Keri A., Gattineni, Jyothsna
Format: Article
Language:English
Subjects:
Abdomen
Acetaminophen
Acetaminophen - adverse effects
Acid-Base Equilibrium - drug effects
Acidosis
Acidosis - chemically induced
Acidosis - diagnosis
Acids
Amino Acid Metabolism, Inborn Errors - chemically induced
Amino Acid Metabolism, Inborn Errors - complications
Amino Acid Metabolism, Inborn Errors - diagnosis
Analgesics
Analgesics, Non-Narcotic - adverse effects
Antibiotics
Blood
Case reports
Chloride
Clinical Insights
Diabetes
Enzymes
Etiology
Hemodialysis
Humans
Kidney diseases
Medicine
Medicine & Public Health
Metabolic acidosis
Metabolism
Metabolites
Nephrology
Patients
Pediatrics
Peritoneal dialysis
Peritoneal Dialysis - adverse effects
Pneumonia
Pyrrolidonecarboxylic Acid
Renal Insufficiency, Chronic - complications
Risk factors
Urine
Urology
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Description
Summary:While metabolic acidosis is one of the most common complications in patients with chronic kidney disease (CKD), there are several uncommon etiologies that are challenging to diagnose. Here, we describe a patient on peritoneal dialysis who developed high anion gap metabolic acidosis secondary to acquired 5-oxoprolinemia from acetaminophen use. While CKD is a known risk factor for developing this potentially serious complication, this case further highlights how 5-oxoproline accumulation can occur, even with therapeutic dosing of acetaminophen.
ISSN:0931-041X
1432-198X
1432-198X
DOI:10.1007/s00467-024-06396-4