L’acidose pyroglutamique chez une patiente âgée

L’acidose pyroglutamique, initialement décrite dans la population pédiatrique chez des patients présentant des déficits enzymatiques innés, est une cause méconnue d’acidose métabolique à trou anionique augmenté (AMTAA) chez l’adulte (1). Cette forme acquise touche principalement les femmes présentant une pathologie chronique, souffrant de dénutrition et avec des antécédents d’utilisation chronique de paracétamol (2). Au cours des dernières années, plusieurs cas d’acidose pyroglutamique ont été rapportés suite à l’utilisation concomitante de paracétamol et de flucloxacilline (3,4). Nous rapportons ici le cas d’une patiente chez qui le diagnostic d’acidose pyroglutamique a été posé dans un contexte de traitement concomitant par paracétamol et flucloxacilline. Ce cas clinique reflète l’importance de considérer l’acidose pyroglutamique dans le diagnostic différentiel de l’AMTAA sans étiologie clairement identifiée, particulièrement en Gériatrie où les facteurs de risques sont fréquemment présents.[Pyroglutamic acidemia in an elderly patient] Pyroglutamic acidemia, initially described in the pediatric population due to inborn enzymatic deficiencies, is a relatively unknown cause of high anion gap metabolic acidosis (1). Acquired pyroglutamic acidemia is mostly diagnosed in malnourished women suffering from a chronic illness and with a history of chronic acetaminophen use (2). During the past decade, several cases of flucloxacillin- and paracetamol-induced pyroglutamic acidosis have been reported (3,4). We herein report a case of a patient diagnosed with pyroglutamic acidosis in the context of concomitant paracetamol and flucloxacillin treatment. This case report highlights the need to consider pyroglutamic acidosis in the differential diagnosis of high anion gap metabolic acidosis, given its reversibility under appropriate management

Characteristics, practices, and outcomes in a Belgian cohort of incident home hemodialysis patients: A 6-year experience.

Home hemodialysis (HHD) remains underused in patients with kidney failure. Current literature on HHD mostly originates from non-European countries, making generalization difficult. The present study describes patients' profile and practice patterns from a Belgian HHD center, and assesses patient and technique survival and complications associated with HHD. We analyzed data from all our incident patients during a 6-year period. The patient's characteristics were summarized using descriptive statistics. Transition to another therapeutic modality, estimated using a risk model with death and transplantation as competing events, episodes of respite cares and hospitalizations, and access complications were analyzed. Eighty patients (mean age: 47 years; male: 64%) met the inclusion criteria. Fifty-one percent of patients initiated dialysis with a central venous catheter (CVC) and 96% were not assisted. Arterio-venous fistula (AVF) cannulation was performed using buttonhole technique. Standard-frequent HD (47%) and short-frequent low-flow dialysate HD (34%) were mostly used at HHD initiation. Cumulative incidences of technique failure and death were 15%, 24%, and 32% at 1, 2, and 5 years. Incidence rates for respite dialysis and hospitalizations were 2.39 and 0.54 per patient-year of HHD. In comparison with AVF, incidence rate ratios of overall access complications and access-related infections for CVC were 4.3 (95% CI: 3.1-6, p < 0.01) and 4.4 (95% CI: 2.1-10, p < 0.01), respectively. Buttonhole cannulation was complicated by 0.26 (95% CI: 0.15-0.46) infections per 1000 AVF-days. This present study provides important information about patient's profile and practice patterns and safety in a cohort of 80 incident Belgian HHD patients, with encouraging techniques and patient survival