An obtunded male with a history of alcohol abuse presented to the emergency department with metabolic acidosis, an osmolar gap and lactic acidosis. The patient was initially treated for alcohol intoxication due to an extremely high blood alcohol level. Following respiratory failure and intubation, a large volume of dark green liquid was removed via nasogastric suction; bedside fluorescence for ethylene glycol was negative. Twenty-four hours later, the patient’s glomerular filtration rate decreased significantly, serum osmolality was 807, the osmolar gap was 407, complete metabolic panel showed pH of 6.8, sodium of 156 mmol/l, potassium of 7.3 mmol/l, chloride of 116, CO2 of 3.9 and anion gap of 30.7. Blood lactic acid was >56 mmol/l. The patient received emergency haemodialysis. Four days after presentation, the patient began to respond to voice commands and was extubated. Currently, the patient still receives haemodialysis due to ongoing renal failure, but no long-term neurologic complications are evident.
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