危及生命的乙二醇中毒中的假性高乳酸血症

False hyperlactatemia in life-threatening ethylene glycol poisoning.

作者信息

Riquier T, Geri G, Mongardon N, Bourgogne E, Pène F

机构信息

Pharmacy department, Cochin Hospital, groupe hospitalier Paris Centre, assistance publique des hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, faculté de pharmacie, 4, avenue de l'Observatoire, 75006 Paris, France.

Medical Intensive Care Unit, Cochin Hospital, groupe hospitalier Paris Centre, assistance publique des hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, faculté de médecine, 15, rue de l'Ecole-de-Médecine, 75006 Paris, France.

出版信息

Ann Fr Anesth Reanim. 2014 Apr;33(4):e79-81. doi: 10.1016/j.annfar.2014.02.010. Epub 2014 Mar 12.

DOI:10.1016/j.annfar.2014.02.010

PMID:24630168

Abstract

Ethylene glycol poisoning is rare, but prompt diagnosis is crucial, in order to initiate specific treatments. Herein, we report the case of a patient who was admitted to ICU for coma and extreme metabolic acidosis with unexpected hyperlactatemia on initial ICU blood gas analyzer. Ethylene glycol poisoning was diagnosed, and hyperlactatemia was ruled out on a blood sample sent to the biochemistry department. Interference of blood gas analyzers lactate electrodes with metabolites of ethylene glycol were the source of this apparent hyperlactatemia. Symptoms gradually improved and false hyperlactatemia resolved after renal replacement therapy and fomepizole administration. Time course of ethylene glycol concentration showed similar evolution. After initial confirmation of ethylene glycol presence, this biological interference could thus be used as a surrogate of costly and highly specialised dosages.

摘要

乙二醇中毒较为罕见，但及时诊断至关重要，以便启动特定治疗。在此，我们报告一例患者，因昏迷和严重代谢性酸中毒入住重症监护病房（ICU），初始ICU血气分析仪检测发现意外的高乳酸血症。诊断为乙二醇中毒，送至生化科的血样排除了高乳酸血症。血气分析仪乳酸电极受乙二醇代谢物干扰是这种明显高乳酸血症的原因。经肾脏替代治疗和给予甲吡唑后，症状逐渐改善，假性高乳酸血症消失。乙二醇浓度的时间进程显示出相似的变化。在初步确认存在乙二醇后，这种生物干扰因此可作为昂贵且高度专业化检测的替代方法。