Clinical noteA visual schematic for clarifying the temporal relationship between the anion and osmol gaps in toxic alcohol poisoning
Section snippets
Case no. 1
A 23-year-old man presented to the ED for psychiatric clearance for suicidal ideation. Physical examination was unremarkable and routine screening labs for psychiatric clearance were normal: Na 134 mEq/L, Cl 100 mEq/L, HCO3 25 mEq/L, BUN 17 mg/dL, Cr 0.9 mg/dL, anion gap 9, ethanol nondetectable, and urine toxicology screen negative. The patient was transferred to an inpatient psychiatric facility 4 hours after ED arrival. The patient was sent back to the same ED 36 hours later with severe
Discussion
In the year 2000, approximately 5,000 cases of ethylene glycol ingestion and 2,000 cases of methanol ingestion were reported to the American Association of Poison Control Centers (AAPCC) Toxic Exposure Surveillance System (TESS).8 Ethylene glycol is commonly found in antifreeze solutions, deicing solutions, hydraulic brake fluid, foam stabilizers, and chemical solvents. Methanol is commonly found in windshield washing solutions, gas-line antifreeze solutions, paints, solvents, and copier
Conclusion
In cases of suspected toxic alcohol poisoning, use of the “Mountain” can clarify the relationship between the anion gap and the osmol gap and improve the diagnostic use of these screening assays.
Acknowledgements
The authors thank Kirk L. Cumpston, DO, and Sean M. Bryant, MD, for encouraging the practical use of the “Mountain.”
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Methanol, isopropyl alcohol, higher alcohols, ethylene glycol, cellosolves, acetone, and oxalate
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Ethylene glycol poisoning
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