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wikitox:2.2.5.2.2_ethylene_glycol [2018/09/01 09:00] – external edit 127.0.0.1wikitox:2.2.5.2.2_ethylene_glycol [2020/02/17 22:59] (current) – [Serum ethylene glycol concentrations] andrew
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 Metabolism of ethylene glycol and the formation of glycolic and lactic acids produces a raised anion gap metabolic acidosis. It is important to remember that patients who present early following ethylene glycol ingestion, prior to significant ethylene glycol metabolism, may have normal acid-base status and a normal anion gap. This situation signifies a good prognosis, as long as the diagnosis is made and appropriate treatment instituted to prevent the formation of toxic metabolites. Patients who present late following significant ethylene glycol ingestion are likely to have an established raised anion-gap metabolic acidosis. Metabolism of ethylene glycol and the formation of glycolic and lactic acids produces a raised anion gap metabolic acidosis. It is important to remember that patients who present early following ethylene glycol ingestion, prior to significant ethylene glycol metabolism, may have normal acid-base status and a normal anion gap. This situation signifies a good prognosis, as long as the diagnosis is made and appropriate treatment instituted to prevent the formation of toxic metabolites. Patients who present late following significant ethylene glycol ingestion are likely to have an established raised anion-gap metabolic acidosis.
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 +False elevations in lactate may be seen with some point of care analysis machines. In these machine glycolic acid and glyoxylic acid may cross-react with L-lactate oxidase used in blood gas analyzers lactate electrodes to induce false elevation of blood lactate. ([[https://www.ncbi.nlm.nih.gov/pubmed/19041561|Pernet Am J Emerg Med 2009]])
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 ==== Osmolal gap ==== ==== Osmolal gap ====
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   * g/L x 16.1 = mmol/L   * g/L x 16.1 = mmol/L
   * mmol/L x 0.062 = g/L   * mmol/L x 0.062 = g/L
- +  * **mmol/L x 6.2 mg/dL  (note most texts use mg/dL as the reporting units)** 
-A quantitative serum concentration of ethylene glycol may be useful to indicate the need for [[:wikitox:3.2.3.1.1_haemodialysis|haemodialysis]]. Availability of serum ethylene glycol concentrations is often an issue in suspected cases of ingestion, and often the diagnosis has to be made on the basis of history and collaborative biochemical evidence. A peak ethylene glycol concentration of > 50 mg/dL is associated with severe toxicity. A peak of less than 20 mg/dL is not associated with severe toxicity, but this concentration is only reassuring in a clinically well patient without a metabolic acidosis (a low ethylene glycol concentration may be measured in late presenters following metabolism of the parent molecule).+A quantitative serum concentration of ethylene glycol may be useful to indicate the need for [[:wikitox:3.2.3.1.1_haemodialysis|haemodialysis]]. Availability of serum ethylene glycol concentrations is often an issue in suspected cases of ingestion, and often the diagnosis has to be made on the basis of history and collaborative biochemical evidence. A peak ethylene glycol concentration of **> 50 mg/dL**  is associated with severe toxicity. A peak of less than 20 mg/dL is not associated with severe toxicity, but this concentration is only reassuring in a clinically well patient without a metabolic acidosis (a low ethylene glycol concentration may be measured in late presenters following metabolism of the parent molecule).
  
 See the following for lethal concentrations of alcohols and their corresponding osmolal gaps. See the following for lethal concentrations of alcohols and their corresponding osmolal gaps.
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 Osmolal gap=(Ethanol [mg/dL])/3.7 – 0.35 or, in SI units: \\ Osmolal gap (Osmol/kg)=1.25 (Ethanol [mmol/L]) – 0.35 \\ (from [[http://www.ncbi.nlm.nih.gov/pubmed/11719745|Purssell et al]]) Osmolal gap=(Ethanol [mg/dL])/3.7 – 0.35 or, in SI units: \\ Osmolal gap (Osmol/kg)=1.25 (Ethanol [mmol/L]) – 0.35 \\ (from [[http://www.ncbi.nlm.nih.gov/pubmed/11719745|Purssell et al]])
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 ==== Urinary oxalate crystals ==== ==== Urinary oxalate crystals ====