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tachycardia, tachypnoea, altered level of consciousness presence of risk factors features of underlying cause INVESTIGATIONS high anion gap metabolic acidosis (HAGMA) on blood gas normal osmolar gap normal lactate normal beta-hydroxybutyrate high pyroglutamic acid (urine or blood) MANAGEMENT stop exacerbating factors treat sepsis, including: early and appropriate antibiotics source control supportive care and monitoring intubation, ventilation, renal replacement therapy (RRT) as indicated N-acetylcysteine help replenish glutathione stores References and Links LITFL Metabolic Muddle 004 Staph sepsis and an unusual metabolic acidosis Journal articles Dempsey GA, Lyall HJ, Corke CF, & Scheinkestel CD (2000)

Cancer cells harness these redox-sensitive pathways to maintain uncontrolled growth and enhance their proliferative capacity [31, 33]

Monitoring and Follow-Up Once you begin your Pentadecapeptide treatment, we will closely monitor your progress

Reactive oxygen species: friend or foe

Feb 2018;25(2):269-275

Eating glutathione-rich foods like avocado, spinach, and asparagus Supplementing with whey protein Its important to remember that glutathione is constructed from three amino acids