Suggested guide to using lactate gap as a surrogate marker in the diagnosis of ethylene glycol overdose.

IF 2.1 4区医学 Q3 MEDICAL LABORATORY TECHNOLOGY

Annals of Clinical Biochemistry Pub Date : 2024-11-12 DOI:10.1177/00045632241292514

Goce Dimeski, Amanda Holford, Katherine Isoardi

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Abstract

Background: Ethylene glycol (EG) poisoning, if not diagnosed rapidly, can lead to poor patient outcomes. Gas chromatography (GC) is primarily used for EG quantitation which is rarely available, and the turn-around time may be prolonged. Most lactate results from point-of-care (POCT) methods are falsely elevated in EG poisoning compared with automated chemistry analyser results. In combination, the lactate gap (POCT-Automated chemistry) can be used as surrogate marker in just about all laboratories to indicate likely EG toxicity and guide treatment.

Case report: A man presented by ambulance to hospital with severe agitation requiring mechanical ventilation to facilitate ongoing management. Venous blood gas analysis confirmed a high anion gap metabolic acidosis (HAGMA) with an elevated lactate. The lactate and osmolarity measured in the laboratory showed a normal lactate and high osmolarity, giving a large osmolar gap. The patient was immediately commenced on renal replacement therapy for presumed EG poisoning to minimize kidney injury, and the treatment continued for 19 hours. A very high EG concentration was confirmed by GC the next day.

Conclusion: An elevated lactate gap along with a HAGMA and osmolar gap can provide rapid surrogate laboratory data indicating EG poisoning enabling timely treatment and better patient outcomes.

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使用乳酸间隙作为诊断乙二醇过量的替代标志物的建议指南。

背景：乙二醇（EG）中毒如果得不到迅速诊断，会导致患者病情恶化。气相色谱法（GC）主要用于 EG 定量，但这种方法很少能用，而且周转时间可能会延长。与自动化学分析仪的结果相比，大多数护理点（POCT）方法得出的乳酸结果在 EG 中毒时会出现假性升高。在几乎所有实验室中，乳酸盐间隙（POCT-自动生化分析）都可作为替代标记物来指示 EG 可能的毒性并指导治疗：病例报告：一名男性患者因严重躁动被救护车送往医院，需要机械通气以促进持续治疗。静脉血气分析证实其患有高阴离子间隙代谢性酸中毒（HAGMA），且乳酸升高。实验室测量的乳酸和渗透压显示乳酸正常，渗透压较高，渗透压缺口较大。由于推测为 EG 中毒，患者立即开始接受肾脏替代治疗，以尽量减少肾脏损伤，治疗持续了 19 个小时。第二天，经气相色谱仪（GC）证实，患者体内的 EG 浓度非常高：结论：乳酸间隙升高以及 HAGMA 和渗透压间隙可提供快速的替代实验室数据，提示 EG 中毒，以便及时治疗，改善患者预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Clinical Biochemistry Biochemistry, Genetics and Molecular Biology-Clinical Biochemistry

CiteScore

5.20

自引率

4.50%

发文量

期刊介绍： Annals of Clinical Biochemistry is the fully peer reviewed international journal of the Association for Clinical Biochemistry and Laboratory Medicine. Annals of Clinical Biochemistry accepts papers that contribute to knowledge in all fields of laboratory medicine, especially those pertaining to the understanding, diagnosis and treatment of human disease. It publishes papers on clinical biochemistry, clinical audit, metabolic medicine, immunology, genetics, biotechnology, haematology, microbiology, computing and management where they have both biochemical and clinical relevance. Papers describing evaluation or implementation of commercial reagent kits or the performance of new analysers require substantial original information. Unless of exceptional interest and novelty, studies dealing with the redox status in various diseases are not generally considered within the journal''s scope. Studies documenting the association of single nucleotide polymorphisms (SNPs) with particular phenotypes will not normally be considered, given the greater strength of genome wide association studies (GWAS). Research undertaken in non-human animals will not be considered for publication in the Annals. Annals of Clinical Biochemistry is also the official journal of NVKC (de Nederlandse Vereniging voor Klinische Chemie) and JSCC (Japan Society of Clinical Chemistry).