Pyroglutamic acidosis (PGA) - this is not a commonly known condition, but it is a serious and potentially life-threatening complication that can arise from the use of certain medications. A recent case report published in BMJ Case Reports revealed that the combined use of paracetamol and flucloxacillin, a type of penicillin antibiotic, can lead to PGA, causing a high anion gap metabolic acidosis (HAGMA).
This case involved a 75-year-old woman who was hospitalised due to an acute kidney injury and nausea, following treatment for Staphylococcus aureus bacteraemia secondary to pneumonia. She was initially treated with intravenous piperacillin and tazobactam, then switched to intravenous flucloxacillin while she completed her antibiotic course from home with hospital in the home (HITH) service. However, five weeks later, she returned to the hospital with increasing nausea and worsening kidney function, which was ultimately diagnosed as the PGA caused by the use of both flucloxacillin and long-term use of paracetamol.
PGA is a rare condition that results from an accumulation of pyroglutamic acid (5-oxoproline) in the blood and urine. This acid is typically excreted in the urine or processed by an enzyme known as pyroglutamate hydrolase. However, the combined use of certain drugs such as paracetamol and flucloxacillin can inhibit this enzyme, leading to the accumulation of pyroglutamic acid in the body.
This condition can lead to an HAGMA, characterized by an elevated anion gap, metabolic acidosis, and symptoms such as nausea, vomiting, and confusion. Notably, the use of homocysteine control products can help to regulate the pyroglutamate hydrolase enzyme, and thus prevent or alleviate some of the symptoms associated with PGA.
Homocysteine is a metabolic byproduct that can accumulate in the body as a result of decreased activity of pyroglutamate hydrolase. Homocysteine control products, which are composed of various nutrients like folate, B6, and B12 vitamins, and betaine, can help to regulate homocysteine metabolism, reducing the risk of accumulating pyroglutamic acid in the body.
It is important to note that while the use of these products may help regulate homocysteine metabolism and prevent HAGMA related to PGA, they should not be used in place of prescribed medication or under the guidance of a healthcare professional.
Overall, PGA, as illustrated in this case report, can have serious consequences, and healthcare professionals and patients alike must be aware of this hidden risk. If you are taking medications that may inhibit the pyroglutamate hydrolase enzyme, consulting your healthcare provider and discussing potential side effects, such as HAGMA, is important. Additionally, considering the use of homocysteine control products could be a proactive measure to regulate homocysteine metabolism and reduce the likelihood of PGA-related complications.