> -----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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