17 January 2022
: Case report 
Severe Anion Gap Metabolic Acidosis Resulting from Combined Chronic Acetaminophen Toxicity and Starvation Ketosis: A Case Report and Literature Review
Challenging differential diagnosis, Adverse events of drug therapy, Rare coexistence of disease or pathology
Thomas Kalinoski1ABCDEF*DOI: 10.12659/AJCR.934410
Am J Case Rep 2022; 23:e934410
Table 3. Comparison of clinical characteristics of published cases.
| Acetaminophen dose (g/day) | Co-ingestions | Serum | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| pH (7.31-7.41) | pCO2 (mmHg, 41–51) | HCO3 (meq/L, 22–29) | Anion Gap (meq/L, 6–12) | Na+(meq/L, 135–145) | BUN (mg/dL, 6–24) | Cr (mg/dL, 0.74–1.35) | Glucose (mg/dL, 70–99) | |||
| Trevor-Jones []5 | 4.0 | None | 7.11 | 19 | 9.1 | 22 | 145 | 17.9 | 3.50 | 146 |
| Hunter []6 | – | Alcohol | 7.19 | 14 | 11 | 19 | 140 | – | 3.49 | – |
| 4.0 | Alcohol | – | – | 9.0 | 20 | 140 | 10.2 | 2.10 | 85 | |
| – | Flucloxacillin | 7.41 | 23 | 14 | 7 | 138 | 1.6 | 0.62 | 101 | |
| 1.0 | None | 7.51 | 16 | 15 | 27 | 139 | 9.6 | 1.66 | 91 | |
| 1.0 | Flucloxacillin | – | – | 14 | 16 | 145 | 5.3 | 0.86 | – | |
| Hodgman []7 | – | Alcohol | 7.02 | 10 | 3.0 | 33 | 148 | 17 | 1.7 | 128 |
| Bersselaar []9 | 3.0 | Flucloxacillin | 7.16 | 53 | 18 | 18 | 143 | – | 1.79 | – |
| Zand Irani [,]10 | – | Flucloxacillin | 7.26 | 20 | 9.0 | 17 | 137 | 6.2 | 2.33 | – |
| – | Dicloxacillin | 7.31 | 27 | 14 | 21 | – | 28 | 3.67 | 256 | |
| Nordstrom O’Brian []11 | – | Alcohol | 7.10 | 7 | 28 | – | 6.4 | 0.79 | – | |
| Duewall []12 | – | None | 7.09 | 28 | 10 | 22 | 140 | 59 | 3.6 | – |
| Hundemer []13 | 1.3 | None | 7.29 | 27 | 12 | 28 | – | – | 0.9 | – |
| Kortmann []15 | 4.0 | Flucloxacillin | 7.12 | 11 | 3.5 | 30 | 143 | – | – | – |
| – | Alcohol | 7.20 | 27 | 10 | 28 | 141 | – | 1.75 | – | |
| 3.0 | None | 7.29 | 23 | 10 | 29 | 142 | – | 2.07 | – | |
| Howie []16 | 3.0 | None | 7.26 | 9.5 | 4.2 | 25 | 134 | – | 0.89 | 49 |
| Fenves []17 | – | None | – | – | 8 | 47 | 145 | 123 | 5.9 | 85 |
| – | None | 6.88 | 28 | 8 | 33 | 131 | – | 2.0 | 534 | |
| – | Alcohol | 7.16 | 14 | 5 | 24 | 143 | – | – | 166 | |
| 2.7 | None | 7.44 | 14 | 8 | 35 | 145 | 15 | 2.2 | 159 | |
| “–“ indicates that parameter was not indicated in cited article. | ||||||||||
| Acetaminophen dose (g/day) | Co-ingestions | Serum | Urine | |||||||
| Lactate (mmol/L, 0.5–2.2) | Acetamino-phen level (mcg/ml, <2) | 5-Oxo-proline (µmol/L, 20–50) | Ketones (mg/dL, negative) | Ethanol (mmol/L, negative) | 5-Oxo-proline (mmol/mol Cr, <70) | Ketones (mg/dL, negative) | ||||
| Trevor-Jones []5 | 4.0 | None | 1.2 | – | – | 21 | – | 700 | – | |
| Hunter []6 | – | Alcohol | 1.7 | – | – | – | – | “+++” | Negative | |
| 4.0 | Alcohol | 0.7 | – | – | – | – | “+++” | “++” | ||
| – | Flucloxacillin | – | – | – | – | – | “+++” | – | ||
| 1.0 | None | 1.5 | – | – | – | – | “+++” | – | ||
| 1.0 | Flucloxacillin | 0.9 | – | – | – | – | “+++” | Negative | ||
| Hodgman []7 | – | Alcohol | 3.1 | 49 | – | Negative | Negative | 2350 | – | |
| Bersselaar []9 | 3.0 | Flucloxacillin | 1.1 | – | – | – | – | 1721 | – | |
| Zand Irani [,]10 | – | Flucloxacillin | – | – | 7467 | – | – | 1700 | – | |
| – | Dicloxacillin | 1.3 | – | 62 | – | – | – | – | ||
| Nordstrom O’Brian []11 | – | Alcohol | 5.2 | 24 | – | – | Negative | 2000 | – | |
| Duewall []12 | – | None | 0.4 | Negative | – | “1: 8” | Negative | 8555 | – | |
| Hundemer []13 | 1.3 | None | 0.8 | Negative | – | – | – | 17455 | Negative | |
| Kortmann []15 | 4.0 | Flucloxacillin | 0.7 | 3.2 | 6573 | – | – | 16,623 | Negative | |
| – | Alcohol | 1.3 | 12 | 2292 | – | – | 4184 | Negative | ||
| 3.0 | None | 1.6 | – | 1050 | – | – | – | Negative | ||
| Howie []16 | 3.0 | None | 1.6 | 14 | – | – | – | 4970 | “+” | |
| Fenves []17 | – | None | “Normal” | – | – | Negative | Negative | 700 | – | |
| – | None | 15 | 6.8 | 6400 | Negative | – | – | – | ||
| – | Alcohol | 2.5 | – | 2800 | Negative | Negative | 1000 | – | ||
| 2.7 | None | 4.3 | – | 1050 | Negative | – | 2470 | – | ||
| “–“ indicates that parameter was not indicated in cited article. | ||||||||||