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Dear Bill:
 
I had never heard of doing this. We recommend use of the osmol gap to detect non-ethanol alcohol ingestions (high osmol gap with negative ethanol result), but even that is problematic. If you compare, for example, the variability in the osmol gap (both physiologic and analytical variability) with the threshold for treatment of methanol poisoning by hemoperfusion, you find that the osmol gap is not sensitive enough to detect clinically significant exposures. I would also point out that some laboratories measure osmoalaity by vapor pressure, and this method does not produce reliable results when volatiles are present in the specimen.
 
In my opinion, even a breathalyzer would be far superior to using osmol gap to detect ethanol.
 
Roger
 
Roger L. Bertholf, Ph.D.
Associate Professor of Pathology
Director of Clinical Chemistry & Toxicology
University of Florida Health Science Center/Jacksonville
-----Original Message-----
From: Borland, Bill [mailto:[log in to unmask]]
Sent: Thursday, June 05, 2003 5:31 AM
To: [log in to unmask]
Subject: 'Screening' test for alcohol

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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------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content.

ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/