Increased Osmolal Gap in Alcoholic Acidosis

Braden, Gregory

doi:10.1001/archinte.1993.00410200103013

Cited by 29 publications

(9 citation statements)

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“…The concentration in this patient (2¢5 mmol/ L) is very high compared to a serum concentration of 0¢1-0 ¢ 5 mmol/ L found in patients with AKA or related condition. 14,17 Such a high concentration suggests that acetone and glycerol were present in much more signi¢cant quantities, as reported by Braden et al 12 The example presented in this paper demonstrates that the osmolar gap in AKA may not be as wide as was previously thought and it must therefore be used with caution as a diagnostic tool.…”

Section: Discussionsupporting

confidence: 71%

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Major ketogenesis and the absence of an osmolar gap in an atypical case of alcoholic ketoacidosis

Renom

Maisonneuve²,

Kim

et al. 2003

Ann Clin Biochem

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A new case of alcoholic ketoacidosis (AKA) is presented because of unusual clinical and biochemical features. Although it shares some similarities with typical cases of AKA, it appears as unique because of predominantly neurological, rather than abdominal symptoms, major ketogenesis with normal ketone body ratio, the presence of large amounts of propanediol and the absence of an osmolar gap. Ann Clin Biochem 2003; 40: 424-426

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Section: Discussionsupporting

confidence: 71%

“…Moreover, in our case, the entire anion gap can be accounted for by the ketones. The nature of the gap remains largely obscure in most reported cases, 6,11 except in one case 12 where the anion gap was equal to the sum of b-hydroxybutyrate and lactate.…”

Section: Discussionmentioning

confidence: 95%

Major ketogenesis and the absence of an osmolar gap in an atypical case of alcoholic ketoacidosis

Renom

Maisonneuve²,

Kim

et al. 2003

Ann Clin Biochem

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“…In a patient with an established metabolic acidosis from toxic alcohol ingestion, a normal or low osmolal gap can occur if blood is sampled after the volatile alcohols have been converted to the acid metabolites (59 ). Increases in the osmolal gap can occur in patients with multiple organ failure and other unmeasured osmolal entities (60,61 ), and can falsely suggest toxic alcohol exposure. A low osmolal gap is a poor discriminator as well.…”

Section: E Osmolality Measurements For Toxic Alcohol Surveillancementioning

confidence: 99%

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Recommendations for the Use of Laboratory Tests to Support Poisoned Patients Who Present to the Emergency Department

et al. 2003

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Background: Exposure to drugs and toxins is a major cause for patients' visits to the emergency department (ED).Methods: Recommendations for the use of clinical laboratory tests were prepared by an expert panel of analytical toxicologists and ED physicians specializing in clinical toxicology. These recommendations were posted on the world wide web and presented in open forum at several clinical chemistry and clinical toxicology meetings. Results: A menu of important stat serum and urine toxicology tests was prepared for clinical laboratories who provide clinical toxicology services. For drugs-ofabuse intoxication, most ED physicians do not rely on results of urine drug testing for emergent management decisions. This is in part because immunoassays, although rapid, have limitations in sensitivity and specificity and chromatographic assays, which are more definitive, are more labor-intensive. Ethyl alcohol is widely tested in the ED, and breath testing is a convenient procedure. Determinations made within the ED, however, require oversight by the clinical laboratory. Testing for toxic alcohols is needed, but rapid commercial assays are not available. The laboratory must provide stat assays for acetaminophen, salicylates, co-oximetry, cholinesterase, iron, and some therapeutic drugs, such as lithium and digoxin. Exposure to other heavy metals requires laboratory support for specimen collection but not for emergent testing. Conclusions: Improvements are needed for immunoassays, particularly for amphetamines, benzodiazepines, opioids, and tricyclic antidepressants. Assays for new drugs of abuse must also be developed to meet changing abuse patterns. As no clinical laboratory can provide services to meet all needs, the National Academy of Clinical Biochemistry Committee recommends establishment of regional centers for specialized toxicology testing. © 2003 American Association for Clinical Chemistry PreambleThis is the ninth in the series of Laboratory Medicine Practice Guidelines sponsored by the National Academy Clinical Chemistry 49:3 357-379 (2003) Special Report 357of Clinical Biochemistry (NACB). 10 An expert Committee of emergency department (ED) physicians and clinical laboratory medicine toxicologists was assembled and prepared recommendations on the use of clinical laboratory tests to support the diagnosis and management of the poisoned patient who presents to the ED. Excluded from these discussions were drug testing conducted for the workplace, forensic and medical examiner toxicology, athletic drug testing, and testing for various compliance programs (e.g., criminal justice, psychiatric, and physician health). Many of these other programs are guided by other recommendations and regulations, such as the Substance Abuse and Mental Health Services Administration, the American Academy of Forensic Sciences, and the International Olympic Committee. Recommendations for detection of drugs in pregnant women and newborns exposed during the intrauterine period are discussed in a previous NACB guidelines (1 ). Som...

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“…On the other hand previous studies have found a close association between serum values of osmolality and ethanol [26]. In some patients with alcoholic acidosis the osmolal gap may not accurately reflect serum ethanol concentration [27].…”

Section: Discussionmentioning

confidence: 79%

QT Interval Dispersion in Acute Alcohol Intoxication

Aasebø¹

2016

International Journal of Advance in Medical Science

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Alcohol intoxication is probably the most common intoxication worldwide. Some studies have suggested an association between QT interval dispersion (QTd) and the risk of arrhythmias. The aim of this report is to assess how alcohol in potential lethal blood concentrations affects QTd. Eighty-four patients were included in analyses. QTd at admittance was compared with a control group (n = 27) and with QTd at discharge. Univariate and multivariate logistic regression analyses were performed in order to explore odds ratio for dispersion including several variables. Mean QTd was 48.6 msec (SD: 13.9) in alcohol intoxicated patients compared to 40.8 msec (SD: 16.5) in the controls (p = 0.019). QTd was larger at admission than at discharge in patients with alcohol intoxication (49.7 msec (13.3) vs. 41.9 (13.8). P = 0.032). Mean blood alcohol level was 2.9‰ in the study group.High to very high blood alcohol concentration may increase QT interval dispersion.

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Increased Osmolal Gap in Alcoholic Acidosis

Cited by 29 publications

References 1 publication

Major ketogenesis and the absence of an osmolar gap in an atypical case of alcoholic ketoacidosis

Major ketogenesis and the absence of an osmolar gap in an atypical case of alcoholic ketoacidosis

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Recommendations for the Use of Laboratory Tests to Support Poisoned Patients Who Present to the Emergency Department

QT Interval Dispersion in Acute Alcohol Intoxication

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