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Case Reports
. 2019 Apr 3;11(4):e4375.
doi: 10.7759/cureus.4375.

Ethylene Glycol Toxicity in the Setting of Recurrent Ingestion: A Case Report and Literature Review

Daniel Loriaux  1 , Stephen P Bergin  2 , Sweta M Patel  2 , Jesse Tucker  2 , Christina E Barkauskas  2
Affiliations
Case Reports

Ethylene Glycol Toxicity in the Setting of Recurrent Ingestion: A Case Report and Literature Review

Daniel Loriaux et al. Cureus. .

Abstract

Ethylene glycol (EG) poisoning is a toxicologic emergency requiring high clinical suspicion and early diagnosis to prevent life-threatening complications. Direct EG quantification methods involve cumbersome and time-consuming laboratory tests of limited utility in the emergency setting. Accordingly, the osmolal gap is frequently employed as a surrogate screening method in cases of suspected toxic alcohol poisoning. However, the osmolal gap has several inherent limitations to be considered when used as a diagnostic tool for EG toxicity. Although many of these limitations are widely acknowledged, the clinical finding of a normal serum osmolal gap in the setting of recurrent toxic alcohol exposure is an observation that has remained largely unexplored. The purpose of this case report is to characterize the accelerated osmolal gap to anion gap conversion that may occur in the setting of chronic toxic alcohol abuse.

Keywords: ethylene glycol toxicity; osmolal gap.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Noncontrast computed tomography imaging
Noncontrast head computed tomography imaging acquired 7 hours and 36 hours after presentation revealing interval development of basal ganglia and midbrain hypoattenuation. Although nonspecific, these radiographic findings are consistent with ethylene glycol toxicity.
Figure 2
Figure 2. Autopsy findings
Photomicrographs showing diffuse calcium oxalate deposition throughout the renal parenchyma, a finding pathognomonic for ethylene glycol poisoning.
Figure 3
Figure 3. Osmolal gap to anion gap conversion
Visual schematic depicting the relationship between the osmolal gap (solid line) and anion gap. (dashed line). As ethylene glycol is metabolized into toxic, non-osmotic metabolites (i.e. glycolate), the osmolal gap decreases and the anion gap begins to rise.
See this image and copyright information in PMC

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