Analgesia to acidosis: metabolic acidosis due to chronic acetaminophen (paracetamol) use.

This case describes a rare occurrence of high anion gap metabolic acidosis due to chronic acetaminophen (paracetamol) usage, which can be confirmed by measuring 5-oxoproline (pyroglutamate), an organic acid metabolite. As acetaminophen is an extremely common drug prescribed in both inpatient and outpatient settings, a high degree of clinical suspicion is required to isolate it as the aetiology for metabolic acidosis. Management includes discontinuation of acetaminophen use and at times the supplementation of oral bicarbonate. Metabolic acidosis due to a high anion gap is commonly described by the mnemonic 'MUDPILES' in daily practice. A newer mnemonic, 'GOLD MARK' is proposed to be a more inclusive tool to assist in determining the cause of high anion gap metabolic acidosis, especially with such cases being reported.

Patient expectations of hypertension and diabetes medication: Excessive focus on short-term benefits.

OBJECTIVES: The objectives of this study are to assess patient perspectives on their perceived benefits of hypertension and diabetes medications and determine associations between perceived benefits and demographics, adherence, and disease control. METHODS: We interviewed 60 adults with type 2 diabetes and hypertension on oral medications. Participants were asked what benefits they expected from taking their medications. Transcripts were analyzed using a modified template approach. Benefits were categorized into short-term, long-term, or misconceptions (e.g. "medications cure diabetes"). Associations between perceived benefits and demographics, adherence, hemoglobin A1c, and blood pressure were analyzed. RESULTS: In general, participants had relatively high self-reported medication adherence and well-controlled disease. All participants identified benefits of their hypertension medications; however, only 85% identified benefits of their diabetes medications. Half described only short-term benefits (e.g. lower blood sugar) (48%); almost one-third described both short- and long-term benefits (e.g. prevent complications) (30% and 28%, respectively). In multivariate analysis, participants with higher comorbidity were more likely to name long-term benefits of hypertension medications (odds ratio 13.3 (1.8-97.8), p = 0.01). DISCUSSION: Participants perceived short-term benefits of hypertension and diabetes medications more often than long-term benefits; participants with higher comorbidity identified more long-term benefits. Further studies are warranted to determine whether additional education on long-term benefits may improve adherence.