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As acetone was present is isopropanol ingestion a possibility? There was a report (Ascher DM. Lost in the game of gaps. Lancet 2002;360:373) which highlighted the case of a 58 year old woman with diabetic ketoacidosis, whose metabolic acidosis with high anion and osmolar gaps was mistakenly attributed to methanol or ethylene glycol ingestion (sorry I haven't got the reference to hand to give you the details). Hope this helps Mike Dr Mike Bosomworth Consultant Clinical Biochemist Acting Head of Clinical Biochemistry and Immunology - LTHT >>> "Simpson, Elliott (MK) Top Grade Biochemist Laboratory Directorate" <[log in to unmask]> 05/11/2004 13:36:55 >>> Last month we had a known diabetic patient (aged 19) admitted who was initially thought to be a DKA. He was confused, agitated and had a convulsion and meningitis was considered at one point. His blood hydrogen ion was 142 nmol/L and it was thought that his serum glucose of 27.4 mmol/L was not high enough to believe that this was all due to the DKA. 24 hours after his admission, his renal output appeared to drop and the ITU staff wondered if he might have drunk ethylene glycol. He had been at a party prior to his admission but his ethanol level was undetectable. We did osmolalities on his admission and 24 hour post admission specimens. There was an osmolality gap (osmolality minus twice the sodium, minus the glucose, minus the urea) of 45 on admission and four at 24 hours. GCMS (in retrospect) ruled out ethylene glycol and ethyl or methyl alcohol but showed an acetone of 8.5 mmol/L Does anyone know what the osmolality gap is likely to be in an uncomplicated DKA? Elliott Simpson Deputy Clinical Director Clinical Support Services Directorate Please note my e-mail address is now:- [log in to unmask] *********************************************************************************************************************************************** NHS Lanarkshire Confidentiality and Disclaimer Notice ****************************************** This email is intended only for the addressee named above and the contents should not be disclosed to any other person or copies taken. Any views or opinions presented are solely those of the sender and do not necessarily represent those of NHS Lanarkshire (NHSL) unless otherwise specifically stated. As Internet communications are not secure NHSL do not accept legal responsibility for the contents of this message or responsibility for any change made to this message after the original sender sent it. We advise you to carry out your own virus check before opening any attachment, as we cannot accept liability for any damage sustained as a result of any software viruses. ------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/ ------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/