1. UNEXPLAINED OSMOL GAP FOLLOWING LACQUER THINNER INGESTION
- Author
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Brubacher, JR, Pudek, M, and Filiatrault, L
- Subjects
Solvent abuse -- Case studies ,Thinner (Paint mixing) -- Health aspects ,Environmental issues ,Health ,Pharmaceuticals and cosmetics industries - Abstract
Background: The osmol gap is commonly used as a marker for toxic alcohol poisoning. We recently treated a patient who ingested lacquer thinner. No toxic alcohol was detected but over an 8 hour period the osmol gap increased from 15 mmol/kg to 31 mmol/kg. Case Report: The patient presented after ingesting ~250 mL of lacquer thinner. He had a solvent odor to his breath and was drowsy with slurred speech and nystagmus. Vitals were normal. Ethanol, salicylates, and acetaminophen were not detected. Electrolytes and blood gases were normal. The anion gap was 4 mmol/L. The osmol gap was 15 mmol/kg. An ethanol infusion was started. Three hours later methanol, ethylene glycol, acetone, and isopropanol were reported as negative but the osmol gap (accounting for ethanol) had increased to 20.5 mmol/kg. Ethanol was continued and serum reanalyzed. At 9 hours the osmol gap had increased to 31 mmol/kg but no toxic alcohols were detected and the patient had regained his normal mental status. Ethanol was stopped and the patient was discharged to psychiatry. Laboratory Methods: Three serum samples were analyzed by gas chromatography with head space analysis. No toxic alcohol was detected but volatile substances later identified as methyl ethyl ketone, toluene and xylene were present. We were unable to quantify these substances but the toluene and xylene peaks increased with time. Conclusion: We have presented a patient with an elevated osmol gap following lacquer thinner ingestion. Methyl ethyl ketone, toluene and xylene appear to have contributed to the osmol gap and should be considered when confronted with an unexplained osmol gap. Ongoing absorption and inhibition of hepatic metabolism likely contributed to the observed increase in osmol gap., Brubacher JR, Pudek M, Filiatrault L. Vancouver General Hospital, Vancouver, British Columbia, [...]
- Published
- 1999