There are numerous kits available for ethanol measurement which are straightforward to "automate" making it just as easy to run as glucose and urea.
I'd much prefer to do this at 3am than measure osmololality and calculate osmolal gap!
Bryan Hill
Automated Services Manager
Clinical Biochemistry and Immunology
Leeds Teaching Hospitals NHS Trust
Leeds General Infirmary
Tel. 0113 3922544
e-mail [log in to unmask]
Please visit our web site at www.leedsteachinghospitals.com
>>> Jonathan Kay <[log in to unmask]> 06/05/03 07:45pm >>>
Seems to work OK for us. In practice clinicians request "ethanol" and
we measure the osmolar gap... they don't request "osmolar gap".
We refer requests for individual alcohols to a toxicology unit.
Occasionally we have to remind clinicians that it may be necessary to
treat before the results of assaying individual alcohols are available
A and E handbooks should have guidance on ethanol, methanol and
ethylene glycol poisoining, written in collaboration with the lab... I
think it is important the timing aspects are in the protocol.
Methanol poisoning is very rare in the UK compared to the USA...
Was this point covered in the Annals review of toxicology requirements?
Jonathan
On Thursday, Jun 5, 2003, at 10:30 Europe/London, Borland, Bill wrote:
> I would be interested to hear any views on the use of the Osmolal Gap
> as a screening test for Ethanol. (Coakley at al, Pathology, 1983,15,
> 321)
>
> One of the A&E departments within our Trust uses the Osmolal Gap as a
> 'screening' test for alcohol and in only a few clinical situations do
> they require a more specific assay for ethanol. They have used the Gap
> in this way for many years and I suspect were encouraged to do this by
> the lab in the days when it was easier to measure serum osmolality
> than ethanol, especially out of hours.
>
> The danger is that junior medical staff may not be aware of the
> limitations of this approach and delay identification of a possible
> methanol or ethylene glycol poisoning. Should we be discouraging them?
>
> It would be useful to find out the practice in other centres.
>
> William Borland
> Principal Biochemist (Toxicology)
> Biochemistry Department
> North Glasgow NHS Trust
> Gartnavel General Hospital
> Glasgow G12 0YN
> Tel 0141 211 3343
> Fax 0141 211 3452
> Email bill.borland.wg@northglasgow .scot.nhs.uk
>
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