期刊
OBSTETRICS AND GYNECOLOGY
卷 137, 期 5, 页码 877-880出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/AOG.0000000000004351
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Acetaminophen use can lead to 5-oxoprolinemia and metabolic acidosis, caution should be taken during pregnancy. N-acetylcysteine may be an effective antidote for pregnant women with high anion gap metabolic acidosis.
BACKGROUND: Although acetaminophen is commonly used in pregnancy, it can deplete glutathione concentrations and cause accumulation of 5-oxoproline, with subsequent metabolic acidosis. CASE: A malnourished 25-year-old woman, G2P1001, with chronic acetaminophen use presented with abdominal pain and high anion gap metabolic acidosis. After ruling out other potential causes, her urine 5-oxoproline level was found to be elevated. She received N-acetylcysteine, with resolution of the acidosis. CONCLUSION: Those who care for pregnant patients should remain alert to 5-oxoprolinemia as a cause of metabolic acidosis during pregnancy. Care must be taken when using acetaminophen in states of malnutrition. N-acetylcysteine seems to be an effective antidote.
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