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Acid-base disturbances

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.

References
  1. Mani S, Rutecki GW. A patient with altered mental status and an acid-base disturbance. Cleve Clin J Med 2017; 84:27–34.
  2. Tan EM, Kalimullah E, Sohail MR, Ramar K. Diagnostic challenge in a patient with severe anion gap metabolic acidosis. Case Rep Crit Care 2015; 2015:272914.
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Michael Emmett, MD, MACP
Baylor University Medical Center, Dallas, TX

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Cleveland Clinic Journal of Medicine - 84 (3)
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Acid-base disturbances, metabolic acidosis, anion gap, osmol gap, acetaminophen, pyroglutamic acid, Michael Emmett
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Michael Emmett, MD, MACP
Baylor University Medical Center, Dallas, TX

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Michael Emmett, MD, MACP
Baylor University Medical Center, Dallas, TX

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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.

References
  1. Mani S, Rutecki GW. A patient with altered mental status and an acid-base disturbance. Cleve Clin J Med 2017; 84:27–34.
  2. Tan EM, Kalimullah E, Sohail MR, Ramar K. Diagnostic challenge in a patient with severe anion gap metabolic acidosis. Case Rep Crit Care 2015; 2015:272914.
References
  1. Mani S, Rutecki GW. A patient with altered mental status and an acid-base disturbance. Cleve Clin J Med 2017; 84:27–34.
  2. Tan EM, Kalimullah E, Sohail MR, Ramar K. Diagnostic challenge in a patient with severe anion gap metabolic acidosis. Case Rep Crit Care 2015; 2015:272914.
Issue
Cleveland Clinic Journal of Medicine - 84 (3)
Issue
Cleveland Clinic Journal of Medicine - 84 (3)
Page Number
181
Page Number
181
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Acid-base disturbances
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Acid-base disturbances
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Acid-base disturbances, metabolic acidosis, anion gap, osmol gap, acetaminophen, pyroglutamic acid, Michael Emmett
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Acid-base disturbances, metabolic acidosis, anion gap, osmol gap, acetaminophen, pyroglutamic acid, Michael Emmett
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