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Increased osmolal gap in alcoholic acidosis
G L Braden1, C H Strayhorn, M J Germain
1Department of Medicine, Baystate Medical Center, Springfield, Mass.
Archives of Internal Medicine
|October 25, 1993
Summary
In alcoholic patients, elevated endogenous glycerol and acetone, not just toxic alcohols, can cause an increased osmolal gap. This finding helps explain metabolic acidosis in alcoholics.
Area of Science:
- Clinical Biochemistry
- Toxicology
- Internal Medicine
Background:
- Alcoholic patients often present with metabolic acidosis and an increased osmolal gap.
- Traditionally, toxic alcohol ingestion is presumed to be the cause of an elevated osmolal gap in this population.
Observation:
- A patient with alcoholic acidosis and an increased osmolal gap was studied.
- Serum analysis revealed elevated levels of glycerol, acetone, acetol, and 1,2-propanediol.
- Ethyl alcohol and other common osmolality-increasing compounds were not detected.
Findings:
- Endogenous glycerol, acetone, and its metabolites significantly contributed to the osmolal gap, accounting for up to 92% at 3 hours post-admission.
- The resolution of the osmolal gap correlated with the correction of acidosis and decreased serum glycerol and acetone levels.
Implications:
- Elevated endogenous glycerol, acetone, and acetone metabolites should be considered as causes of an increased osmolal gap in alcoholic patients.
- The assumption that only toxic alcohol ingestion causes an increased osmolal gap in alcoholics is challenged.
- This expands the differential diagnosis for metabolic disturbances in patients with alcoholism.
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