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Recurrent 'Lactic' Acidosis-a Cautionary Tale.
1Specialist Registrar in Diabetes and Endocrinology Southampton General Hospital Tremona Road Southampton SO16 6YD.
Acute Medicine
|May 26, 2011
Summary
Recurrent lactic acidosis may indicate ethylene glycol poisoning. Glycolic acid, a metabolite, can be falsely measured as lactic acid by some analyzers, complicating diagnosis. Increased awareness is crucial for accurate patient management.
Area of Science:
- Toxicology
- Clinical Chemistry
- Internal Medicine
Background:
- Lactic acidosis is a serious condition with diverse causes.
- Ethylene glycol poisoning is a known but less common cause of metabolic acidosis.
- Point-of-care analyzers are widely used for rapid diagnostic testing.
Purpose of the Study:
- To report a case of recurrent lactic acidosis misdiagnosed due to ethylene glycol poisoning.
- To highlight the issue of spurious lactic acid measurement caused by glycolic acid.
- To increase awareness among clinicians about this diagnostic challenge.
Main Methods:
- Case presentation of a patient with recurrent 'lactic' acidosis.
- Review of relevant medical literature on ethylene glycol poisoning and metabolic acidosis.
- Discussion of analytical interferences in point-of-care testing.
Main Results:
- The patient's recurrent acidosis was ultimately attributed to ethylene glycol poisoning.
- Glycolic acid, a metabolite of ethylene glycol, can interfere with lactic acid assays on certain analyzers.
- This interference can lead to misdiagnosis and delayed treatment.
Conclusions:
- Ethylene glycol poisoning should be considered in cases of unexplained or recurrent lactic acidosis.
- Clinicians must be aware of potential analytical interferences, such as glycolic acid mimicking lactic acid.
- Enhanced diagnostic vigilance is necessary for managing complex metabolic acidosis cases.
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