Alhamad Tarek, Blandon Jimena, Meza Ana T, Bilbao Jorge E, Hernandez German T
Division of Nephrology, Department of Internal Medicine, Penn State College of Medicine, Penn State University, Hershey, Pennsylvania, USA.
Division of Nephrology & Hypertension, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
J Nephropathol. 2013 Apr;2(2):139-43. doi: 10.12860/JNP.2013.23. Epub 2013 Apr 1.
Ethylene glycol ingestion can lead to acute kidney injury from tubular deposition of oxalate crystals. The diagnosis of ethylene glycol intoxication is based on a history of ingestion, clinical examination, high anion gap metabolic acidosis, high osmolal gap, and a measured serum level of ethylene glycol. However, depending on the delay in time from ingestion to arrival to a hospital, the osmolal gap may become normal, thereby creating a confusing clinic picture for the treating clinician.
A 71 year-old man with a history of alcohol abuse had been unconscious for an unknown period of time. Upon hospitalization, he was found to have a high anion gap metabolic acidosis but a normal serum osmolal gap and subsequently developed acute kidney injury. The serum lactic acid and glucose levels were unremarkable, and there were no ketones in the serum. Urine analysis showed numerous red blood cells and calcium oxalate crystals. The renal biopsy showed multiple oxalate crystals in the renal tubules demonstrating birefringence under polarized light. Given the history of alcohol abuse, the clinical presentation, the unexplained high anion gap metabolic acidosis, and the biopsy findings, ethylene glycol intoxication was deemed the most likely diagnosis.
In cases of ethylene glycol intoxication, a high serum osmolal gap is supportive of ethylene glycol intoxication, but a normal serum osmolal gap does not exclude the diagnosis, especially when the time of ingestion is unknown. Physicians should be aware of potentially normal serum osmolal gap values in cases of ethylene glycol intoxication.
摄入乙二醇可因草酸盐晶体在肾小管沉积而导致急性肾损伤。乙二醇中毒的诊断基于摄入史、临床检查、高阴离子间隙代谢性酸中毒、高渗透压间隙以及测定的血清乙二醇水平。然而，根据从摄入到入院的时间延迟，渗透压间隙可能恢复正常，从而给主治医生造成临床情况混乱。
一名有酗酒史的71岁男性已昏迷一段时间，原因不明。入院时，发现他有高阴离子间隙代谢性酸中毒，但血清渗透压间隙正常，随后发展为急性肾损伤。血清乳酸和葡萄糖水平无异常，血清中无酮体。尿液分析显示有大量红细胞和草酸钙晶体。肾活检显示肾小管中有多个草酸盐晶体，在偏振光下呈双折射。鉴于其酗酒史、临床表现、无法解释的高阴离子间隙代谢性酸中毒以及活检结果，乙二醇中毒被认为是最可能的诊断。
在乙二醇中毒病例中，高血清渗透压间隙支持乙二醇中毒诊断，但血清渗透压间隙正常并不能排除诊断，尤其是在摄入时间不明的情况下。医生应意识到乙二醇中毒病例中血清渗透压间隙值可能正常。
