Tuesday, July 3, 2018

Toxic alcohol ingestion / KULTS

The Tox and The Hound (EMCrit)
Tox and Hound - July 2, 2018 - By Meghan Spyres
..."Toxic alcohols are a perfect example of the type of diagnostic challenge that drives us. Ethylene glycol (EG), methanol (MeOH), and isopropanol levels are almost universally unavailable in real time. The differential diagnosis for a toxic alcohol ingestion is huge, and although the alternative diagnoses are much more common, missing the diagnosis can sentence a patient to renal failure, permanent blindness, or death. Even more, toxic alcohol ingestions are accompanied by a great nemesis, a persistent villain that haunts nearly every consult: the osmol gap (OG).
But can’t we use the OG to make (or exclude) the diagnosis of toxic alcohols? Haven’t we been ordering this lab test for years, cognitively offloading any worry about tox as soon as the low OG results? Am I really going to ruin this for you? Yes, of course I am. Far from a quick fix solution, the OG remains one of the more misunderstood tests in medicine...