An unusual cause of high anion gap metabolic acidosis: pyroglutamic acidosis

Rj Wardell,La Burrows,A Marsh,K Myall

doi:10.1186/cc10755

Abstract

Metabolic acidosis is a common acid-base disturbance in intensive care. A high anion gap indicates the presence of endogenous acids, which in critically ill patients are most commonly ketones, lactate and those accumulated in renal failure. However, excluding these causes means more rare forms of acid must be considered, including pyroglutamic acidosis. Pyroglutamic acidosis is caused by the accumulation of 5-oxoproline [1] due to the depletion of glutathione. This leads to loss of negative feedback and therefore the build-up of Y-glutamyl cysteine, which is converted to 5-oxoproline.

Highlights

Sepsis is primarily a disease of the aged and 60% of sepsis occurs in patients older than 65 years, 80% of deaths due to sepsis occur in this age group
The purpose of the study is to elucidate the immunological changes that occur in Klotho mice after sepsis in order to identify therapeutic targets for sepsis that occurs in aged individuals
Poor survival in Klotho-septic mice may be associated with impaired bacterial clearance with decreased recruitment of neutrophils/macrophages in peritoneal cavity, elevated cytokines in serum, and increased apoptosis in thymus and spleen, following to impaired innate and adaptive immunity

Summary

Introduction

Sepsis is primarily a disease of the aged and 60% of sepsis occurs in patients older than 65 years, 80% of deaths due to sepsis occur in this age group. The aim of this study was to determine the reasons behind out-of-hours discharges in our hospital and the effect this has on mortality This audit reviewed the discharge process of patients from an adult general ICU to the general wards before and after the introduction of a liaison nurse post over a 3-year, 3-month time period. The aim of this study was to establish and compare the quality and value of the summaries as judged by ICU doctors and GPs. The relationship between provider volume and patient outcome has been demonstrated for many medical and surgical services, including critical care. Methods In this single-centre observational study we aimed to quantify functional dependency at three different time points: discharge from ICU (DI), discharge from hospital (DH) and discharge from nursing home rehabilitation unit (DR) To this end we retrospectively assed Barthel scores (BS) for individual patients [1], with a duration of mechanical ventilation >48 hours.

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