Michael Emmett, MD, MACP

To the Editor: In their article “A patient with altered mental status and an acid-base disturbance,”¹ Drs. Shylaja Mani and Gregory W. Rutecki state that 5-oxoproline or pyroglutamic acidosis is associated with an elevated osmol gap. This is not the case. The cited reference by Tan et al² describes a patient who most likely had ketoacidosis, perhaps complicated by isopropyl alcohol ingestion.

Those disorders can certainly generate an osmol gap. Although pyroglutamic acidosis was mentioned in the differential diagnosis of that case, that condition was never documented. The accumulation of 5-oxoproline or pyroglutamic acid should not elevate the serum osmolality or generate an osmol gap.

To the Editor: In their article “A patient with altered mental status and an acid-base disturbance,”¹ Drs. Shylaja Mani and Gregory W. Rutecki state that 5-oxoproline or pyroglutamic acidosis is associated with an elevated osmol gap. This is not the case. The cited reference by Tan et al² describes a patient who most likely had ketoacidosis, perhaps complicated by isopropyl alcohol ingestion.

Those disorders can certainly generate an osmol gap. Although pyroglutamic acidosis was mentioned in the differential diagnosis of that case, that condition was never documented. The accumulation of 5-oxoproline or pyroglutamic acid should not elevate the serum osmolality or generate an osmol gap.

To the Editor: In their article “A patient with altered mental status and an acid-base disturbance,”¹ Drs. Shylaja Mani and Gregory W. Rutecki state that 5-oxoproline or pyroglutamic acidosis is associated with an elevated osmol gap. This is not the case. The cited reference by Tan et al² describes a patient who most likely had ketoacidosis, perhaps complicated by isopropyl alcohol ingestion.

Those disorders can certainly generate an osmol gap. Although pyroglutamic acidosis was mentioned in the differential diagnosis of that case, that condition was never documented. The accumulation of 5-oxoproline or pyroglutamic acid should not elevate the serum osmolality or generate an osmol gap.

To the Editor: Stephen et al¹ have written a nice review of the implications of albuminuria. However, they are clearly incorrect when they state, “Most of the protein in the urine is albumin filtered from the plasma.”¹ First, as they later point out in the article, the normal upper limit of protein excretion is about 150 mg/day, and only about 20 mg/day is normally albumin. Therefore, most of the protein in normally found in urine is not albumin, but instead is mostly a variety of globulins. Tamm-Horsfall mucoprotein or uromodulin is usually the protein found in highest concentration in normal urine.

To the Editor: Stephen et al¹ have written a nice review of the implications of albuminuria. However, they are clearly incorrect when they state, “Most of the protein in the urine is albumin filtered from the plasma.”¹ First, as they later point out in the article, the normal upper limit of protein excretion is about 150 mg/day, and only about 20 mg/day is normally albumin. Therefore, most of the protein in normally found in urine is not albumin, but instead is mostly a variety of globulins. Tamm-Horsfall mucoprotein or uromodulin is usually the protein found in highest concentration in normal urine.

To the Editor: Stephen et al¹ have written a nice review of the implications of albuminuria. However, they are clearly incorrect when they state, “Most of the protein in the urine is albumin filtered from the plasma.”¹ First, as they later point out in the article, the normal upper limit of protein excretion is about 150 mg/day, and only about 20 mg/day is normally albumin. Therefore, most of the protein in normally found in urine is not albumin, but instead is mostly a variety of globulins. Tamm-Horsfall mucoprotein or uromodulin is usually the protein found in highest concentration in normal urine.