Journal of Advanced Intensive and Critical Care Medicine

Abstract

Pyroglutamic acidosis is an infrequent cause of high anion gap metabolic acidosis (HAGMA). Also known as 5-oxoprolinemia, it is often under-recognized in critically ill patients however remains an important differential to consider. It results from the disruption of the glutathione cycle due to factors such as sepsis, medication use, and malnutrition. We present a case of acquired pyroglutamic acidosis in a 43-year-old female with chronic comorbidities and sepsis. The case illustrates multiple factors associated with 5-oxoproline accumulation and provides insight into the principles of management and safe reintroduction of contributing agents.