A pre-hospital team is managing a 50-year-old male who has ingested antifreeze (ethylene glycol) approximately 3 hours ago. He is confused and ataxic....

Question

A pre-hospital team is managing a 50-year-old male who has ingested antifreeze (ethylene glycol) approximately 3 hours ago. He is confused and ataxic. His blood gas shows a severe metabolic acidosis with pH 7.12, high anion gap, and an osmolar gap. What does the combination of high anion gap acidosis WITH an osmolar gap suggest?

Accepted Answer

Toxic alcohol ingestion (ethylene glycol or methanol) - the osmolar gap is caused by the parent alcohol, and the anion gap is caused by the toxic metabolites (glycolic acid/oxalic acid from ethylene glycol, or formic acid from methanol)

Answer

Normal anion gap metabolic acidosis from diarrhoea

Answer

Diabetic ketoacidosis - which always has an osmolar gap

Answer

Simple lactic acidosis from dehydration

Answer

Renal tubular acidosis

uk-dipimc MCQ (SBA): Toxic Alcohol - Anion and Osmolar Gap