High anion gap metabolic acidosis secondary to pyroglutamic aciduria (5-oxoprolinuria): association with prescription drugs and malnutrition

Ann Clin Biochem. 2007 Jul;44(Pt 4):406-9. doi: 10.1258/000456307780945769.


Two cases of High Anion Gap Metabolic Acidosis (HAGMA) due to pyroglutamic acid (5-oxoproline) are described. In both cases the HAGMA developed during an episode of hospital treatment, in conjunction with paracetamol and antibiotic prescription, and the surviving patient made an uneventful recovery after the drugs were withdrawn. Clinicians need to be aware of this cause for metabolic acidosis because it may be a more common metabolic disturbance in compromised patients than would be expected, and the discontinuation of drugs implicated in the aetiology is therapeutic.

Publication types

  • Case Reports

MeSH terms

  • Acetaminophen / adverse effects*
  • Acid-Base Equilibrium / drug effects*
  • Acidosis / chemically induced*
  • Acidosis / drug therapy
  • Aged, 80 and over
  • Analgesics, Non-Narcotic / adverse effects*
  • Anti-Bacterial Agents / adverse effects*
  • Female
  • Humans
  • Male
  • Malnutrition*
  • Middle Aged
  • Pyrrolidonecarboxylic Acid / urine*


  • Analgesics, Non-Narcotic
  • Anti-Bacterial Agents
  • Acetaminophen
  • Pyrrolidonecarboxylic Acid