scholarly journals Ethylene Glycol Poisoning with a Near-Normal Osmolal Gap: A Diagnostic Challenge

Cureus ◽  
2020 ◽  
Author(s):  
Moeed Ahmed ◽  
Cliff Janikowski ◽  
Syed Huda ◽  
Aiza Ahmad ◽  
Lee Morrow
Keyword(s):  
Ethylene Glycol ◽  
Diagnostic Challenge ◽  
Ethylene Glycol Poisoning ◽  
Osmolal Gap

scholarly journals Diagnostic Challenge in a Patient with Severe Anion Gap Metabolic Acidosis

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Eugene M. Tan ◽  
Ejaaz Kalimullah ◽  
M. Rizwan Sohail ◽  
Kannan Ramar
Keyword(s):  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Anion Gap ◽  
Diagnostic Challenge ◽  
Nursing Facility ◽  
Random Blood Sugar ◽  
Beta Hydroxybutyrate ◽  
Osmolal Gap ◽  
Urine Levels

The approach to the patient with acute renal failure and elevated anion and osmolal gap is difficult. Differential diagnoses include toxic alcohol ingestion, diabetic or starvation ketoacidosis, or 5-oxoproline acidosis. We present a 76-year-old female with type 2 diabetes mellitus, who was found at home in a confused state. Laboratory analysis revealed serum pH 6.84, bicarbonate 5.8 mmol/L, pCO2 29 mmHg, anion gap 22.2 mmol/L, osmolal gap 17.4 mOsm/kg, elevated beta-hydroxybutyrate (4.2 mmol/L), random blood sugar 213 mg/dL, creatinine 2.1 mg/dL, and potassium 7.5 mmol/L with no electrocardiogram (EKG) changes. Fomepizole and hemodialysis were initiated for presumed ethylene glycol or methanol ingestion. Drug screens returned negative for ethylene glycol, alcohols, and acetaminophen, but there were elevated urine levels of acetone (11 mg/dL). The acetaminophen level was negative, and 5-oxoproline was not analyzed. After 5 days in the intensive care unit (ICU), her mental status improved with supportive care. She was discharged to a nursing facility. Though a diagnosis was not established, our patient’s presentation was likely due to starvation ketosis combined with chronic acetaminophen ingestion. Acetone ingestion is less likely. Overall, our case illustrates the importance of systematically approaching an elevated osmolal and anion gap metabolic acidosis.

scholarly journals Acidosis and coma after hemodialysis.

1997 ◽  
Vol 8 (5) ◽  
pp. 853-856
Author(s):  
R Taylor ◽  
J Bower ◽  
M M Salem
Keyword(s):  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Suicide Attempts ◽  
Altered Mental Status ◽  
Anion Gap ◽  
Toxic Metabolites ◽  
Ethylene Glycol Poisoning ◽  
Rapid Clearance ◽  
Dialysate Solution ◽  
Osmolal Gap

Ethylene glycol poisoning is a rare yet potentially fatal illness seen most commonly in association with ingestion by alcoholics or in suicide attempts. It is characterized by an elevated anion gap metabolic acidosis, osmolal gap, calcium oxalate crystals in the urine, and a well-defined clinical picture. Prompt treatment is crucial because effective intervention can prevent the neurologic, cardiac, pulmonary, and renal sequelae associated with ethylene glycol poisoning. Hemodialysis offers rapid clearance of ethylene glycol and its toxic metabolites. In this article, the case of a hemodialysis patient who suffered contamination of the dialysate solution with ethylene glycol, leading to altered mental status, coma, and severe anion gap metabolic acidosis, is reported. Despite prolonged dialysis and correction of the acidosis, the patient remained comatose and subsequently died.

Osmolal and Anion Gaps in Patients Admitted to an Emergency Medical Department

1994 ◽  
Vol 13 (2) ◽  
pp. 131-134 ◽  
Author(s):  
Lars Aabakken ◽  
Kjerstin S. Johansen ◽  
Else-Berit Rydningen ◽  
Jan E. Bredesen ◽  
Steinar Øvrebø ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Ethylene Glycol ◽  
Reference Values ◽  
Medical Department ◽  
Blood Samples ◽  
Emergency Medical ◽  
Unselected Population ◽  
The Mean ◽  
Lactate Levels ◽  
Osmolal Gap

1 Osmolal and anion gaps are helpful in the diagnosis and evaluation of intoxications with methanol and ethylene glycol. Reported reference values for osmolal gap and anion gap are -1 (± 6) mosm kg-1 H2O and 16 (± 2) mmol I -1, respectively. However, we have repeatedly found unexplained increased gaps in patients admitted to our department, and the relevance of the established reference values has been questioned. 2 Osmolal and anion gaps were determined in an unselected population of patients consecutively admitted to an emergency medical department. In the case of unexplained gaps, the blood samples were analysed with respect to the presence of alcohols and organic acids. 3 We included all accessible patients admitted during 14 days. Appropriate blood samples were obtained in 177 patients (88 male, 89 female), with a mean age of 65 years (range 17-94). 4 The mean and (standard deviation) for osmolal and anion gaps in our material were 5.2 mosm kg-1 H2O (7.0) and 12.9 mmol/l (4.2). Neither methanol nor ethylene-glycol was detected in serum from any patients. Small amounts of ethanol were found in 5 patients, and high lactate levels explained in part the most extensively increased anion gaps. However, the calculated analytical standard deviation accounted entirely for the variation in our material, and we suggest that the present reference values be adjusted.

Value of glycolic acid analysis in ethylene glycol poisoning: A clinical case report and systematic review of the literature

2018 ◽  
Vol 290 ◽  
pp. e9-e14 ◽  
Author(s):  
Gaspar Tuero ◽  
Jesús González ◽  
Laura Sahuquillo ◽  
Anna Freixa ◽  
Isabel Gomila ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Report ◽  
Ethylene Glycol ◽  
Glycolic Acid ◽  
Clinical Case ◽  
Review Of The Literature ◽  
Ethylene Glycol Poisoning

Two Fatal Cases of Ethylene Glycol Poisoning

1978 ◽  
Vol 18 (2) ◽  
pp. 102-107 ◽  
Author(s):  
D. A. L. Bowen ◽  
P.S. B. Minty ◽  
A. Sengupta
Keyword(s):  
Ethylene Glycol ◽  
Chromatographic Analysis ◽  
Gas Chromatographic Analysis ◽  
Ethylene Glycol Poisoning ◽  
Salient Features ◽  
Serum And Urine

Two cases of self poisoning by ethylene glycol are reported. The salient features of fatal acute ethylene glycol poisoning are mentioned with detailed histological and toxicological findings. Gas chromatographic analysis was used to determine ethylene glycol levels in serum and urine.

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