Although acetaminophen is routinely used during pregnancy, it has been shown to decrease glutathione levels and promote 5-oxoproline buildup, leading to metabolic acidosis.

G2P1001, a malnourished 25-year-old woman, arrived with stomach discomfort and severe anion gap metabolic acidosis. Her urine 5-oxoproline level was discovered to be high after other possible explanations were ruled out. Her acidosis was resolved once she was given N-acetylcysteine. 

Those who care for pregnant patients should be on the lookout for 5-oxoprolinemia, which can induce metabolic acidosis during pregnancy. When administering acetaminophen in malnutrition, extreme caution should be exercised. The antidote N-acetylcysteine appears to be effective.