Jurnal Internasional Afrika vol. 11 issue 2 2021
African Journal of Emergency Medicine
Response to “Ethylene glycol poisoning: A diagnostic challenge in a patient with persistent seizures and a severe metabolic acidosis”
Dublin Core
Title
Jurnal Internasional Afrika vol. 11 issue 2 2021
African Journal of Emergency Medicine
Response to “Ethylene glycol poisoning: A diagnostic challenge in a patient with persistent seizures and a severe metabolic acidosis”
African Journal of Emergency Medicine
Response to “Ethylene glycol poisoning: A diagnostic challenge in a patient with persistent seizures and a severe metabolic acidosis”
Subject
Response to “Ethylene glycol poisoning: A diagnostic challenge in a patient with persistent
seizures and a severe metabolic acidosis”
seizures and a severe metabolic acidosis”
Description
Smit and colleagues describe a commendable treatment of an
extremely ill patient with ethylene glycol (EG) poisoning with severe
metabolic acidosis [1]. The case also highlights the diagnostic difficulties
with EG poisoning. These difficulties are not unique to Africa.
Most hospitals in the US lack on-site capability to measure EG concentrations.
In the few that can measure EG, the laboratory procedure takes
several hours, so we also rely upon other clues [2].
In addition to the anion gap, the osmolal gap, and the presence of
calcium oxalate crystals in the urine, the unmeasurably high lactate
concentration (reported as >30 mmol/L) is another useful clue for EG
poisoning. There are two common laboratory methods for measuring
lactate. Point-of-care devices (including blood gas analyzers) use lactate
oxidase while hospital laboratories often use a method using lactate
dehydrogenase. Lactate oxidase uses both lactate and glycolate as substrates
and cannot distinguish between the two. In contrast, lactate dehydrogenase
is specific for lactate. A very high point-of-care lactate
suggests EG poisoning [3]. If both tests are available, a discrepancy
between the two resulting in a much higher apparent lactate concentration
by the lactate oxidase method than by the lactate dehydrogenase
method (the “lactate gap”) is highly specific to EG poisoning.
Another option is to employ an assay using glycerol dehydrogenase
[4,5]. In the US, a veterinary diagnostic product (Catachem Inc., Oxford
CT, USA) offers qualitative and quantitative measurement of EG in dogs.
This provides a rapid and sensitive test for ethylene glycol. The test
correlates well with gas chromatography–mass spectrometry (GC–MS)
but has but has not reached widespread clinical use in humans [5].
One test which emergency physicians must avoid is urinary fluorescence
ultraviolet light (Wood’s lamp). Although automotive antifreeze/
coolant liquids contain fluorescein (to assist mechanics in finding
radiator leaks), normal urine and some plastic urine containers also
fluoresce and make this bedside test highly unreliable [6].
extremely ill patient with ethylene glycol (EG) poisoning with severe
metabolic acidosis [1]. The case also highlights the diagnostic difficulties
with EG poisoning. These difficulties are not unique to Africa.
Most hospitals in the US lack on-site capability to measure EG concentrations.
In the few that can measure EG, the laboratory procedure takes
several hours, so we also rely upon other clues [2].
In addition to the anion gap, the osmolal gap, and the presence of
calcium oxalate crystals in the urine, the unmeasurably high lactate
concentration (reported as >30 mmol/L) is another useful clue for EG
poisoning. There are two common laboratory methods for measuring
lactate. Point-of-care devices (including blood gas analyzers) use lactate
oxidase while hospital laboratories often use a method using lactate
dehydrogenase. Lactate oxidase uses both lactate and glycolate as substrates
and cannot distinguish between the two. In contrast, lactate dehydrogenase
is specific for lactate. A very high point-of-care lactate
suggests EG poisoning [3]. If both tests are available, a discrepancy
between the two resulting in a much higher apparent lactate concentration
by the lactate oxidase method than by the lactate dehydrogenase
method (the “lactate gap”) is highly specific to EG poisoning.
Another option is to employ an assay using glycerol dehydrogenase
[4,5]. In the US, a veterinary diagnostic product (Catachem Inc., Oxford
CT, USA) offers qualitative and quantitative measurement of EG in dogs.
This provides a rapid and sensitive test for ethylene glycol. The test
correlates well with gas chromatography–mass spectrometry (GC–MS)
but has but has not reached widespread clinical use in humans [5].
One test which emergency physicians must avoid is urinary fluorescence
ultraviolet light (Wood’s lamp). Although automotive antifreeze/
coolant liquids contain fluorescein (to assist mechanics in finding
radiator leaks), normal urine and some plastic urine containers also
fluoresce and make this bedside test highly unreliable [6].
Creator
Correspondence
Source
www.elsevier.com/locate/afjem
Date
17 February 2021
Contributor
PERI IRAWAN
Format
PDF
Language
ENGLISH
Type
TEXT
Files
Citation
Correspondence, “Jurnal Internasional Afrika vol. 11 issue 2 2021
African Journal of Emergency Medicine
Response to “Ethylene glycol poisoning: A diagnostic challenge in a patient with persistent seizures and a severe metabolic acidosis”,” Repository Horizon University Indonesia, accessed March 13, 2025, https://repository.horizon.ac.id/items/show/2634.
African Journal of Emergency Medicine
Response to “Ethylene glycol poisoning: A diagnostic challenge in a patient with persistent seizures and a severe metabolic acidosis”,” Repository Horizon University Indonesia, accessed March 13, 2025, https://repository.horizon.ac.id/items/show/2634.