Is the osmole gap a valuable indicator for the need of hemodialysis in severe ethanol intoxication?

Up-to-date no indicator for hemodialysis in severe ethanol intoxication is available. In these cases, the benefits have to outweigh the risks and costs of hemodialysis. In this case report, a suicidal patient had ingested 250 ml of 95% ethanol and was found in deep coma. In literature, some cases, especially of adolescents, are described with severe ethanol poisoning and blood ethanol levels above 740 mg/dL. Hemodialysis, if initiated, decreased ethanol levels significantly as compared to peritoneal dialysis, charcoal or gastric lavage and reduced also clinical costs. While recommendations exist for starting dialysis in ethylene glycol or methanol intoxications, no algorithm is available to determine the situations when hemodialysis is required in ethanol intoxication. The osmole gap may serve as an indicator to differentiate, which patients need haemodialysis - right now, the decision depends upon the physicians experience or preference.