I agree, it is unusually high osmolal gap, has this
been repeated on a second sample?
May we ask Dr. Lord about the outcome of this
interesting case.
Has he arrived at a final diagnosis that explains the
very high osmolal gap? has the patient recovered?
thanks
Mohammad
--- "Bertholf, Roger" <[log in to unmask]>
wrote: > > -----Original Message-----
> > It is quite acceptable to add on tests to explain
> an
> > abnormal biochemical finding (a very high osmolar
> gap
> > in this case) which may be the underlying cause of
> > reduced level of consciousness. The absence of
> > acidosis makes methanol and polyethylene glycol
> > poisoning unlikely. Ethanol and isopropyl alcohol
> > intoxications are compatible with this scenario
> and
> > since ethanol was only 10 mg/dL, isopropyl alcohol
> > poisoning is the most likely diagnosis.
>
>
> I am skeptical of the presumptive IPA poisoning
> diagnosis. Assuming a normal
> osmol gap of 5-10 mOsm, a gap of 100 represents at
> least a 90 mOsm elevation
> above normal, which would require a blood IPA
> concentration of over 500
> mg/dL. This likely be a lethal intoxication, and is
> inconsistent with the
> patient's presentation. The same argument applies to
> methanol and ethylene
> glycol, but as Mohammed points out, the absence of
> acidosis makes these
> unlikely.
>
> Roger
>
> Roger L. Bertholf, Ph.D.
> Associate Professor of Pathology
> Director of Clinical Chemistry & Toxicology
> University of Florida Health Science
> Center/Jacksonville
>
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=====
Dr. M A Al-Jubouri
Consultant Chemical Pathologist
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------ACB discussion List Information--------
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