Emergency Department, Royal Perth Hospital, Perth, Australia.
Department of Intensive Care, Royal Perth Hospital, Perth, Australia.
Clin Toxicol (Phila). 2022 Nov;60(11):1248-1250. doi: 10.1080/15563650.2022.2114911. Epub 2022 Aug 31.
Patients with ethanol dependence may consume vanilla extract for the high alcohol content.
A 42-year-old male with ethanol dependence who developed status epilepticus, severe anion gap metabolic acidosis and a hyperosmolar non-ketotic coma after ingestion of 600 mL vanilla essence. He was found to have an osmolar gap of 151 with a marked pseudohypertriglyceridaemia of 96.4 mmol/L (8350 mg/dL), found to be secondary to significantly elevated glycerol levels. The patient required intubation for status epilepticus and dialysis to correct the severe acid-base disturbance and remove excess glycerol. The patient made a full recovery.
Glycerol is traditionally thought to be a nontoxic alcohol, but this represents a severe case of glycerol toxicity requiring treatment with dialysis. It may represent an emerging or underdiagnosed clinical presentation given availability of high-glycerol products. In the right clinical context, pseudohypertriglyceridaemia and altered mental state may be recognised as glycerol intoxication, avoiding the need for unnecessary investigations.
患有乙醇依赖症的患者可能会因高酒精含量而摄入香草精。
一名 42 岁男性，有乙醇依赖症，在摄入 600 毫升香草精后，出现癫痫持续状态、严重阴离子间隙代谢性酸中毒和高渗性非酮症昏迷。检查发现渗透压间隙为 151，假性高甘油三酯血症为 96.4mmol/L（8350mg/dL），这是由于甘油水平显著升高所致。患者因癫痫持续状态需要插管，还需要透析来纠正严重的酸碱紊乱和清除多余的甘油。患者完全康复。
甘油传统上被认为是一种无毒的酒精，但这代表了一种严重的甘油毒性病例，需要用透析治疗。鉴于高甘油产品的可用性，这可能代表了一种新出现的或诊断不足的临床表现。在适当的临床环境下，假性高甘油三酯血症和精神状态改变可能被识别为甘油中毒，从而避免了不必要的检查。
