Glycolate causes the acidosis in ethylene glycol poisoning and is effectively removed by hemodialysis.

Acta medica Scandinavica Pub Date : 1984-01-01
D Jacobsen, S Ovrebø, J Ostborg, O M Sejersted
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Abstract

Six male patients with severe ethylene glycol poisoning were studied with respect to the origin of the metabolic acidosis. The plasma concentrations of ethylene glycol were 4-41 mmol/l and treatment included alkali, ethanol and hemodialysis. Plasma analysis by isotachophoresis and whole blood lactate determinations showed that glycolate (17.0-29.3 mmol/l), lactate (1.4-6.2 mmol/l) and beta-hydroxybutyrate (less than or equal to 1.8 mmol/l) were present in elevated concentrations contributing to the acidosis. Oxalate (less than or equal to 0.33 mmol/l), glyoxylate (less than 0.2 mmol/l) and formate (less than 0.4 mmol/l) concentrations were negligible and did not contribute to any significant degree to the acidosis. The elevated plasma glycolate concentration was highly correlated to the anion gap (r = 0.923) and the glycolate made up for 96.1% (n = 6, range 84.7-108.8) of the increased anion gap. We conclude that glycolate accumulation is the main reason for the metabolic acidosis in ethylene glycol poisoning. The mean dialysator (1.6 m2) clearances of glycolate at a blood flow of 200 ml/min in two patients were 137 ml/min (n = 9, SD +/- 8, range 125-149) and 144 ml/min (n = 11, SD +/- 8, range 133-158). By applying first order kinetics during hemodialysis a volume of distribution of glycolate of 0.55 l/kg was found, assuming that the dialysator clearance equals the total body clearance of glycolate. Thus glycolate, the probable main metabolite of ethylene glycol, is efficiently removed by hemodialysis.

乙二醇中毒中乙醇酸引起酸中毒,可通过血液透析有效清除。
本文对6例男性严重乙二醇中毒患者代谢性酸中毒的病因进行了研究。血浆中乙二醇浓度为4 ~ 41 mmol/l,治疗方法包括碱、乙醇和血液透析。血浆等速电泳分析和全血乳酸测定显示,乙醇酸(17.0-29.3 mmol/l)、乳酸(1.4-6.2 mmol/l)和β -羟基丁酸(小于或等于1.8 mmol/l)浓度升高,导致酸中毒。草酸盐(小于或等于0.33 mmol/l)、乙醛酸盐(小于0.2 mmol/l)和甲酸盐(小于0.4 mmol/l)的浓度可以忽略不计,对酸中毒没有任何显著的影响。血浆乙醇酸浓度升高与阴离子间隙升高高度相关(r = 0.923),乙醇酸占阴离子间隙增加的96.1% (n = 6,范围84.7 ~ 108.8)。我们认为乙醇酸积累是乙二醇中毒代谢性酸中毒的主要原因。两例患者在血流量为200 ml/min时,透析器(1.6 m2)对乙醇酸的平均清除率分别为137 ml/min (n = 9, SD +/- 8,范围125-149)和144 ml/min (n = 11, SD +/- 8,范围133-158)。通过在血液透析过程中应用一级动力学,假设透析器清除率等于乙醇酸的全身清除率,发现乙醇酸的体积分布为0.55 l/kg。因此,乙二醇可能的主要代谢物乙醇酸可通过血液透析有效地去除。
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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