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Abstract: TH-PO395

Factitious Lactate Elevation: A Clue for Ethylene Glycol Poisoning

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Pendyala, Reshub R., Nichols School, Buffalo, New York, United States
  • Chepur, Anjana, Uplift North Hills Preparatory School, Irving, Texas, United States
  • Pendyala, Prashant, Buffalo General Medical Center, Buffalo, New York, United States
Introduction

Ethylene glycol poisoning is a medical emergency, and an early diagnosis is imperative for proper treatment. In most of the institutions the turnaround time for a direct measurement takes a few hours. Severe metabolic acidosis with an elevated osmolar gap can give a clue in the appropriate clinical setting. We describe a case of factitious lactic acid elevation using blood gas analyzers (point of care) in this group of patients. This could be an additional indicator to support a diagnosis of ethylene glycol poisoning.

Case Description

50 yr old lady was found by family in bed, unresponsive, and with labored respirations. She was intubated in the field for airway protection given her poor GCS, and transported to the emergency department. She was afebrile but hypertensive and initially needed nicardipine drip for BP control. Labs were significant for leucocytosis of 34000, anion gap 30, serum bicarbonate 5, lactate 15 (obtained on blood gas analyzer), pH 6.90. Sodium 148, Chloride 113, blood glucose 185. Creatine Kinase 47. Initial Creatinine 2.4 and Blood Urea Nitrogen 16. Measured osmolarity was 357 with osmolal gap of 44. Simultaneous lactic acid done in the central laboratory was normal at 0.9. Ethylene Glycol level was significantly increased and was 46. Patient started on sodium bicarb, fomepizole, thiamine and folinic acid and pyridoxine, monitoring BMP and VBG every 4 hours. Patient underwent hemodialysis. Eventually her acidosis improved, and she was extubated.

Discussion

Ethylene glycol gets metabolized in liver and form glycolic acid and glyoxylic acid. These compounds cross react with L-lactate oxidase used in point of care blood gas analyzers and release hydrogen peroxide that is measured as a surrogate for the level of lactate. This results in a false elevation of lactate. A concurrent lactate level performed in the central laboratory using ion selective electrodes was normal. There is usually a very good correlation between point of care analyzers and the central laboratory in measuring lactic acid in various clinical situations. This discrepancy and a factitious elevation of lactic acid can be an important clue for the diagnosis of ethylene glycol poisoning.