BMJ Case Reports 2018; doi:10.1136/bcr-2018-224243
  • Novel diagnostic procedure

Lactate gap as a tool in identifying ethylene glycol poisoning

  1. Brandy J Mckelvy1
  1. 1Department of Pulmonary, Critical Care and Sleep Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
  2. 2Department of Pulmonary Medicine, MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Carlos A Jimenez, cajimenez{at}
  • Accepted 25 February 2018
  • Published 9 March 2018


Ethylene glycol toxicity is a known cause of anion gap metabolic acidosis, with the presence of an osmolar gap and the right clinical context suggesting to the diagnosis. Rapid recognition and early treatment is crucial. Unfortunately, ethylene glycol levels are not readily available and must be performed at a reference laboratory. We present a case where recognising the significance of the ‘lactate gap’ assisted in identifying ethylene glycol poisoning.


  • Contributors AESS, CAJ and BJM: conception and design, acquisition of laboratory data, drafting the article, critical revision of intellectual content and final approval of the version to be published.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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