Elevated Osmolal Gap in a Case of Multiple Myeloma
Ratna Malkan1, Michael Baillio1, Han T Gao1
1Department of Emergency Medicine, University of Texas Health Science Center, San Antonio, Texas.
The Journal of Emergency Medicine
|February 25, 2024
Summary
An elevated osmolal gap in patients with altered mental status can indicate toxic alcohol ingestion. However, emergency physicians should also consider other causes like renal failure and multiple myeloma.
Area of Science:
- Clinical Chemistry
- Toxicology
- Emergency Medicine
Background:
- Serum osmolality measures blood solutes like sodium, glucose, and urea.
- Toxic alcohols (methanol, ethylene glycol) can elevate measured serum osmolality.
- The osmolal gap is the difference between measured and calculated osmolality.
Observation:
- A patient with alcohol use disorder presented with altered mental status and an elevated osmolal gap.
- The patient received fomepizole, thiamine, and hemodialysis.
- This case highlights the importance of investigating elevated osmolal gaps.
Findings:
- Elevated osmolal gap can result from toxic alcohol ingestion, renal failure, or multiple myeloma.
- Differential diagnosis for osmolal gap elevation is crucial in emergency settings.
- Prompt treatment with fomepizole, thiamine, and hemodialysis was initiated.
Implications:
- Emergency physicians must consider diverse etiologies for elevated osmolal gaps.
- Differentiating toxic alcohol ingestion from other causes is critical for appropriate management.
- Understanding the differential diagnosis aids in timely and effective patient care.
