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  • Two gaps too many, three clues too few? Do elevated osmolal and anion gaps with crystalluria always mean ethylene glycol poisoning?

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Reminder of important clinical lesson
CASE REPORT
Two gaps too many, three clues too few? Do elevated osmolal and anion gaps with crystalluria always mean ethylene glycol poisoning?
  1. Maneesh Gaddam1,
  2. Ravi Kanth Velagapudi1,
  3. Emad Abu Sitta1,2,
  4. Abed Kanzy3
  1. 1Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
  2. 2Michigan State University
  3. 3Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
  1. Correspondence to Dr Emad Abu Sitta, emademad70{at}hotmail.com

Summary

A 60-year-old African-American man with a medical history significant for heavy alcohol abuse, hypertension, delirium tremens, nephrolithiasis and seizure disorder was brought to the hospital with altered mental status. He was found to have high anion gap metabolic acidosis with significantly elevated lactate along with an elevated osmolal gap and calcium oxalate crystals in his urine. With this combination of findings, ethylene glycol poisoning was high in the differential. This case report describes why ethylene glycol poisoning was not the diagnosis in this patient despite the presence of these three classic laboratory findings, therefore emphasising the fact that these findings should not be taken at face value because they can be seen collectively in a patient yet each have a different cause.

  • poisoning
  • adult intensive care
  • alcohol-related disorders

https://doi.org/10.1136/bcr-2017-221739

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    Footnotes

    • Contributors MG: primary resident taking care of patients, reviewed the literature and wrote the manuscript. RKV: secondary resident, reviewed the literature and wrote the manuscript. AK: primary care physician, reviewed the literature and the manuscript. EAS: attending, reviewed the literature and wrote the manuscript.

    • Competing interests None declared.

    • Patient consent Obtained.

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