Correct!
5. All of the above
There are a number of causes of a metabolic acidosis with an elevated anion and osmolal gap. These include, severe circulatory shock, hyperosmolar therapy, lactic acidosis, and chronic kidney disease, however, most of these are easily clinically recognizable (4). However, ingestion of the alcohols is a common clinical cause of metabolic acidosis with elevated anion and osmolal gaps that are not always easily diagnosed. Laboratory evaluation for the alcohols is often not readily available other than ethanol and therapy should begin prior to laboratory confirmation. Our patient’s ethanol level was 0 mg/dL.
Ethylene glycol and methanol result in a large osmolal gap while ethanol usually results in a small or no osmolal gap (5,6). Fluorescein is usually added to antifreeze which is the most common cause of ethylene glycol ingestion to make detection of leaks in liquid cooled engines easily detectable. This can be taken advantage of by examining the patient’s urine under a black light which can be available as a Wood’s lamp. In addition, metabolites of ethylene glycol can accumulate and form calcium oxalate crystals in the urine.
Which of the following can be used to treat organic alcohol ingestion? (Click on the correct answer to be directed to the sixth and final page)