Can someone put me straight on the formula for
measuring/calculating osmolar gap? Is it the
difference between the "calculated" and measured
osmolality? Is there now a reference/standard for
calculating osmolality?
It think it might be OK to "suggest" the probability
of an alcohol ingestion in the light of a significant
"osmolar gap", but.............
David Brown
--- Jonathan Kay <[log in to unmask]> wrote:
> 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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