(BMJ)—A 52-yo man was brought to the ED w/ confusion & SOB. Exam: agitated; RR, 28/min. Labs: VBG: pH 7.02, pCO2 26, pO2 31; lactate, 59 mg/dL; glucose, 128 mg/dL; anion gap, 19 mEq/L; creatinine, 1.6 mg/dL; osmolality, 318 mOsm/kg; osmolal gap, 20 mOsm/kg; EtOH neg; UTox neg; UA: (+)blood, (-)ketones; urine micro: (+)crystals. What is the dx?
Methanol poisoning
Isopropyl alcohol poisoning
Propylene glycol poisoning
Ethylene glycol poisoning
Diethylene glycol poisoning
You are correct. Ethylene glycol poisoning is characterized by high anion gap metabolic acidosis, high serum osmolality in the absence of urine ketones or marked hyperglycemia, acute kidney injury, and presence of urinary crystals. Glycolic acid, a metabolite of ethylene glycol, can lead to a falsely raised blood lactate concentration. Short-term tx includes fomepizole and hemodialysis.
By vgreene, 18 August, 2016

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