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Case Reports
. 2011 Jul 20:2011:bcr0520114292.
doi: 10.1136/bcr.05.2011.4292.

Refractory metabolic acidosis in patients with sepsis following hemiarthroplasty for femoral neck fracture: a causative role for paracetamol and flucloxacillin?

Halima Amer  1 , Frances Dockery, Nicholas Barrett, Marc George, Karolina Witek, Jeremy Stanton, Diane Back
Affiliations
Case Reports

Refractory metabolic acidosis in patients with sepsis following hemiarthroplasty for femoral neck fracture: a causative role for paracetamol and flucloxacillin?

Halima Amer et al. BMJ Case Rep. .

Abstract

The authors report two cases of pyroglutamic acidosis as a result of paracetamol and flucloxacillin therapy in patients with prosthesis infection following hemiarthroplasty for neck of femur fractures. Pyroglutamic acidosis is an important and often unrecognised cause of refractory metabolic acidosis that disproportionately affects older women, and can be caused by drugs such as paracetamol and flucloxacillin in the setting of sepsis, renal failure and malnutrition. Although relatively rare, the widespread use of these drugs in orthopaedic patients confirms the importance of this disorder.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Organic acid gas chromatography-mass spectrometry (GC-MS) analysis for patient 1.
Figure 2
Figure 2
Organic acid gas chromatography-mass spectrometry (GC-MS) analysis for patient 2.
See this image and copyright information in PMC

References

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