scholarly journals Lactate Gap: A Diagnostic Support in Severe Metabolic Acidosis of Unknown Origin

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Linn E. Hauvik ◽  
Mercy Varghese ◽  
Erik W. Nielsen
Keyword(s):  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Point Of Care ◽  
Unknown Origin ◽  
Medical Emergency ◽  
Severe Metabolic Acidosis ◽  
Ethylene Glycol Poisoning ◽  
The Difference ◽  
Lactate Levels ◽  
Elevated Lactate

Ethylene glycol poisoning is a medical emergency. The metabolites glycolate and glyoxylate give metabolic acidosis. Because of similar structure, these metabolites are misinterpreted as lactate by many point-of-care blood gas analyzers. The falsely high lactate values can lead to misdiagnosis, inappropriate laparotomies, and delayed antidotal therapy. As laboratory analyzers measure plasma lactate only, the difference or the “lactate gap” aids in early diagnosis. We present a patient with severe metabolic acidosis and elevated lactate levels on the point-of-care analyzer. A lactate gap supported the diagnosis of ethylene glycol poisoning. Hemodialysis and fomepizole treatment could be started immediately.

scholarly journals CONCOMITANT INGESTION OF ETHYLENE GLYCOL AND ETHANOL: A DIAGNOSIS TRAP?

2015 ◽  
Vol 64 (3) ◽  
pp. 282-284
Author(s):  
Otilia-Elena Frasinariu ◽  
◽  
Aniela Rugina ◽  
Cristina Jitareanu ◽  
Radu Russu ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Severe Metabolic Acidosis ◽  
Subsequent Evolution ◽  
Positive History ◽  
Toxic Metabolites ◽  
Central Nervous System Depression ◽  
Ethylene Glycol Poisoning ◽  
Suicidal Attempts ◽  
Rule Out

Ethylene glycol is one of the most toxic alcohols; it may be accidentally or intentionally consumed as a substitute for ethanol or related to suicidal attempts. Ingestion of ethylene glycol causes a severe metabolic acidosis with increased anion and osmotic gap due to its toxic metabolites, leading to a clinical picture of central nervous system depression, cardiovascular and renal impairment. A 16-year-old boy was admitted with clinical and biological signs of ethylene glycol poisoning after simultaneous ingestion of antifreeze and ethanol. The patient had mild anion gap metabolic acidosis only at the debut, rapidly corrected with one dose of sodium bicarbonate; further evaluation did not reveal acidosis, even if the subsequent evolution included acute renal failure requiring hemodialysis. Due to the absence of a positive history and of a persistent metabolic acidosis, the diagnosis of ethylene glycol poisoning was delayed until it was confirmed by serum toxicological test. Conclusions: concomitant ingestion of ethanol may mask the symptoms of ethylene glycol poisoning; the absence of persistent metabolic acidosis does not rule out the diagnosis.

Predictors of Mortality Among Very Low Birth Weight Infants With Gastrointestinal Perforation

2020 ◽  
pp. 000313482095692
Author(s):  
Marina L. Reppucci ◽  
Eliza H. Hersh ◽  
Prerna Khetan ◽  
Brian A. Coakley
Keyword(s):  
Metabolic Acidosis ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Severe Metabolic Acidosis ◽  
Related Factors ◽  
Vlbw Infants ◽  
Risk Of Death ◽  
Portal Venous Gas ◽  
Elevated Lactate

Background Gastrointestinal (GI) perforation is a risk factor for mortality in very low birth weight (VLBW) infants. Little data exist regarding pretreatment factors and patient characteristics known to independently correlate with risk of death. Materials and Methods A retrospective review of all VLBW infants who sustained GI perforation between 2011 and 2018 was conducted. Birth, laboratory, and disease-related factors of infants who died were compared to those who survived. Results 42 VLBW infants who sustained GI perforations were identified. Eleven (26.19%) died. There were no significant differences in birth-related factors, hematological lab levels at diagnosis, presence of pneumatosis, or bacteremia. Portal venous gas ( P = .03), severe metabolic acidosis ( P < .01), and elevated lactate at diagnosis ( P < .01) were statistically more likely to occur among infants who died. Discussion Portal venous gas, severe metabolic acidosis, and elevated lactate were associated with an increased risk of mortality among VLBW infants who develop a GI perforation. Further research is required to better identify risk factors.

scholarly journals Anion gap‐opening metabolic acidosis and urinary findings in the early diagnosis of ethylene glycol poisoning: A case report

2022 ◽  
Vol 10 (1) ◽  
Author(s):  
Kentaro Ukita ◽  
Kanako Otomune ◽  
Ryo Fujimoto ◽  
Kanako Hasegawa ◽  
Koichi Izumikawa ◽  
...  
Keyword(s):  
Case Report ◽  
Metabolic Acidosis ◽  
Early Diagnosis ◽  
Ethylene Glycol ◽  
Anion Gap ◽  
Ethylene Glycol Poisoning ◽  
Gap Opening

Management of alcohol poisoning

2016 ◽  
Author(s):  
Knut Erik Hovda ◽  
Dag Jacobsen
Keyword(s):  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Delayed Diagnosis ◽  
Unknown Origin ◽  
Symptomatic Treatment ◽  
Toxic Metabolite ◽  
Adequate Treatment ◽  
Alcohol Poisoning ◽  
Long Term Prognosis

Ethyl alcohol poisoning is by far the most common alcohol poisoning, and it can usually be handled by simple symptomatic treatment. Methanol and ethylene glycol poisonings share many characteristics, often presenting with a metabolic acidosis of unknown origin. Obtaining the diagnosis could be difficult, and assays for the toxic alcohol are seldom available at hand. The diagnosis should thus be supported by the use of the anion- and osmolal gaps, and/or a simple and specific formate enzymatic method measuring the toxic metabolite itself. A delayed diagnosis of poisonings will often have fatal consequences, in spite of effective treatment available. Treatment mainly consists of buffer, antidote, haemodialysis, and folinic acid (if methanol is suspected) in addition to supportive care. The long-term prognosis of cerebral (unless hypoxic damage)—and kidney function in ethylene glycol poisonings - is good given adequate treatment. Diethylene glycol is also highly toxic, but the knowledge on toxicity is limited. We recommend treatment similar to ethylene glycol poisonings. Other alcohol poisonings are less severe, and will usually present without pronounced metabolic acidosis.

scholarly journals Ethylene glycol poisoning presenting with a falsely elevated lactate level

2009 ◽  
Vol 47 (3) ◽  
pp. 236-238 ◽  
Author(s):  
Sandra Verelst ◽  
Pieter Vermeersch ◽  
Koen Desmet
Keyword(s):  
Ethylene Glycol ◽  
Lactate Level ◽  
Ethylene Glycol Poisoning ◽  
Elevated Lactate ◽  
Elevated Lactate Level
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