Journal of Advanced Intensive and Critical Care Medicine
Open Access • Peer Reviewed • Bi-Monthly Publication
Hidden in Plain Sight: Pyroglutamic Acidosis as A Cause of Unexplained Hagma
Abstract
Pyroglutamic acidosis is an infrequent cause of high anion gap metabolic acidosis (HAGMA). Also known as 5-oxoprolinemia, it is often under-recognised 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.
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© 2026 The Author(s). Published by WM Journals.
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