Filling In the Gaps: Ethylene Glycol Poisoning Presenting With Isolated Lactate and Osmolar Gaps

Area of Science:

• Toxicology
• Emergency Medicine
• Internal Medicine

Background:

• Ethylene glycol (EG) is a common antifreeze ingredient.
• EG toxicity is rare but can cause severe morbidity and mortality if not diagnosed within 12 hours.
• Typical presentations include lactate gap, osmolar gap, high anion gap acidosis, and acute kidney injury.

Observation:

• A 57-year-old male presented with obtundation, slurred speech, and gait imbalance.
• Initial labs revealed lactate gap, osmolar gap, and non-anion gap acidosis, with an EG level of 112 mg/dL three days post-admission.
• The patient's partner found empty antifreeze and alcohol bottles, suggesting potential ingestion.

Findings:

• Hemodialysis was initiated within eight hours of admission based on the laboratory findings.
• The patient recovered without cardio-pulmonary or renal injury and was extubated.
• The patient admitted to intentional ingestion of antifreeze for self-harm.

Implications:

• This case highlights atypical presentations of EG toxicity, emphasizing the need to avoid diagnostic anchoring.
• Prompt recognition of EG poisoning, even with unusual laboratory findings, is critical for effective treatment.
• Early diagnosis and intervention are essential to prevent severe complications and mortality from ethylene glycol exposure.