Pyroglutamic acid-induced metabolic acidosis: a case report.

High anion gap metabolic acidosisdue to pyroglutamic acid(5-oxoproline) is a rare complication of acetaminophentreatment (which depletes glutathione stores) and is often associated with clinically moderate to severe encephalopathy. Acquired 5-oxoprolinase deficiency (penicillins) or the presence of other risk factors of glutathione depletion such as malnutrition or sepsis seems to be necessary for symptoms development. We report the case of a 55-year-old womenwho developeda symptomatic overproductionof 5-oxoproline during flucloxacillintreatment for severe sepsis while receiving acetaminophenfor fever control. Hemodialysis accelerated the clearance of the accumulated organic acid, and was followed by a sustained clinical improvement.