Severe Hypertriglyceridemia Causing High Anion Gap Metabolic Acidosis in a Patient With Severe Insulin Resistance

Tandon, Parul; Hussain, Faizul; Shakoor, Shakeela; Hammoude, Mohammad A.

doi:10.2337/diaclin.32.3.130

Cited by 2 publications

(4 citation statements)

References 5 publications

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“…Still, recommendations for N-acetylcysteine are on a case-by-case basis [ 6 ]. In some cases, hypertriglyceridemia can be the cause of diabetic ketoacidosis which causes a high anion gap metabolic acidosis [ 7 ]. Serum osmolarity, beta hydroxybutyrate and glucose levels will be high in those cases [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…In some cases, hypertriglyceridemia can be the cause of diabetic ketoacidosis which causes a high anion gap metabolic acidosis [ 7 ]. Serum osmolarity, beta hydroxybutyrate and glucose levels will be high in those cases [ 7 ]. This patient, however, did not have derangements in those parameters and therefore her hypertriglyericedemia, although high, was not the cause of her high anion gap metabolic acidosis as she was also not in ketoacidosis given her negative beta hydroxybutyrate levels [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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5-Oxoprolinemia in a Patient With Severe Hypothyroidism and Chronic Acetaminophen Use

Uczkowski¹,

Gundavarapu²

2023

Cureus

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5-oxoprolinemia is caused by a defect in the gamma-glutamyl pathway which can present with severe anion gap metabolic acidosis not caused by ketoacidosis, lactic acidosis, methanol/ethylene glycol ingestion, renal failure, ethanol, iron/isoniazid or salicylate ingestion. This case will describe a 59-year-old female presenting with elevated anion gap metabolic acidosis with no discernible classical cause, chronic acetaminophen use, malnourishment, and severe hypothyroidism with 5-oxoprolinemia after extensive investigation of other causes. Treatment involved correcting the acidosis with bicarbonate, IV fluid administration, oral levothyroxine and avoiding further acetaminophen use. The patient’s acidosis resolved soon after and she was counseled on the avoidance of acetaminophen in the future. This case highlights the importance of pharmacologic vigilance with everyday over-the-counter medicines such as acetaminophen and metabolic states such as hypothyroidism which can lead to tumultuous cases of metabolic acidosis. This is the first case in which we know that 5-oxoprolinemia has presented with concomitant severe hypothyroidism. Due to this patient’s course, it may have been the preceding factor for the development of her oxoprolinemia alongside her acetaminophen consumption.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

5-Oxoprolinemia in a Patient With Severe Hypothyroidism and Chronic Acetaminophen Use

Uczkowski¹,

Gundavarapu²

2023

Cureus

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“…Osmolar gap is defined as the difference between actual serum osmolarity and calculated serum osmolarity. Increased osmolar gap (defined as >10 mOsm/g [ 3 ]) is caused by hyperlipidemia or hyperproteinemia [ 2 ], sugars (mannitol, sorbitol), and alcohols. Increased osmolar gap is clinically used to screen for toxic alcohol ingestion such as ethanol or certain toxic alcohols, including methanol, ethylene glycol, diethylene glycol, propylene glycol, and isopropanol.…”

Section: Discussionmentioning

confidence: 99%

“…High anion gap metabolic acidosis is mainly caused by an overdose of glycols, 5-oxoproline/pyroglutamic acid, L-lactate, D-lactate, methanol, aspirin, renal failure, and ketoacidosis [ 1 ]. High serum osmolarity with an osmolar gap can be yielded by hyperlipidemia or hyperproteinemia, sugars (mannitol, sorbitol) [ 2 ], and alcohols. High anion gap and high osmolarity with an osmolar gap are two different entities but can co-exist in some instances and can be an essential clue for certain toxic alcohol exposure.…”

Section: Introductionmentioning

confidence: 99%

Elevated Anion Gap Metabolic Acidosis With High Osmolar Gap and Increased Serum Acetone Level: A Case Report

Basuli¹,

Roy²

2022

Cureus

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Acetone poisoning, although not very common, can present with varied signs and symptoms. High acetone levels in serum can be due to exogenous exposure or endogenous production of acetone. Unlike certain alcohol toxicities, acetone does not cause high anion gap metabolic acidosis.A 69-year-old male presented to our service with shock and acute encephalopathy and required intensive care support. Initial laboratory investigation showed high anion gap metabolic acidosis with high osmolar gap. Serum acetone level was elevated. Clinicians need to be aware of how to elucidate such metabolic disturbances and associated toxicities.

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Severe Hypertriglyceridemia Causing High Anion Gap Metabolic Acidosis in a Patient With Severe Insulin Resistance

Cited by 2 publications

References 5 publications

5-Oxoprolinemia in a Patient With Severe Hypothyroidism and Chronic Acetaminophen Use

5-Oxoprolinemia in a Patient With Severe Hypothyroidism and Chronic Acetaminophen Use

Elevated Anion Gap Metabolic Acidosis With High Osmolar Gap and Increased Serum Acetone Level: A Case Report

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