Aerosol pentamidine for Pneumocystis carinii pneumonia.

anion gap (Na[CI+ HCO,)) was20 mEq/L (normal 8-16 mEq/L). The measured serum osmolarity on admission was 423 mOsmol/kg. The calculated serum osmolarity (2Na+ BUN/28 + glucose/I 8) was 306mOsmol/kg (normal 280-295 mOsmol/kg) for an osmolar gap of 117 mOsmol/kg. Urinalysis showedthe urine to beclearand yellow; witha specificgravityof 1.020;pH 6.0; no ketones, blood, albumin, crystals, or casts; and a WBC count of one per high-powered field. Toxicological analysis revealed an initial ethanol blood level of 297 mg/dL and an ethylene glycol blood level of 2100 mg/L (210 mg/dL). Ethyleneglycollevelswerereportedas milligrams per literbythe laboratory throughout this case. The treatment courseof this patient includedan ethanol infusionand hemodialysis.Figure I summarizesthe useof ethanol and the timingof hemodialysis procedures. The presence of a high ethanol concentration on admission is believed to have aided in preventingthis patient from developing a potentially severemetabolicacidosisby inhibiting the metabolismof ethyleneglycol.The initial infusionrate of ethanolchosen(7.5g/h) waslowfor thisyoungalcoholic patient with normal liverfunction. Compensationfor ethanol removedduring hemodialysis was also inadequate, as shown in Figure I. The ethanol infusion wascontinued without change on days 3 and 4; ethanol serum concentrations on these days were again subtherapeutic. Figure I also summarizesall blood concentrationsof ethanol and ethyleneglycolobtained and their relationshipto ongoingtherapy. BEN M. LOMAESTRO, B.S.Pharm. Clinical Specialist Intensive Care Albany Medical Center Albany, New York 12208