Liontos Angelos, Samanidou Valentini, Athanasiou Lazaros, Filippas-Ntekouan Sebastien, Milionis Charalambos
1st Department of Internal Medicine, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Ioannina, GRC.
Cureus. 2023 Apr 8;15(4):e37292. doi: 10.7759/cureus.37292. eCollection 2023 Apr.
Measurement of serum osmolal gap is a useful tool in suspected toxic alcohol ingestion. Normal levels of osmolal gap are typically <10 mOsm/kg). Osmolal gap >20 mOsm/kg is usually caused by ingestion of methanol, ethylene glycol, isopropanol, propylene glycol, diethylene glycol, or organic solvents such as acetone but rarely of ethanol alone. Herein, we describe the case of a severe ethanol intoxication presenting with a marked increase in the osmolal gap. An 18-year-old male was referred to the emergency department of our hospital, in a comatose state, following binge drinking. blood gas analysis revealed a high anion gap metabolic acidosis. In addition, it was found an extremely elevated osmolal gap of 91 mOsm/kg. The increment of the osmolal gap and the high anion gap acidosis could not be attributed to methanol/ethylene glycol intoxication, alcoholic ketoacidosis, or other cause of acidosis. The calculated osmolal concentration of ethanol was 91 mOsm/kg (osmolal concentration of ethanol is equal to the serum ethanol levels (mg/dL) divided by 3.7). Thus, the increase in the osmolal gap was a result of ethanol intoxication solely. Acute, isolated, ethanol intoxication may be a rare cause of a marked increase of osmolal gap with high anion gap metabolic acidosis. Clinicians should be alerted to the possibility of acute ethanol intoxication in a patient presenting with high anion gap metabolic acidosis and an extremely elevated osmolal gap. Toxicologic screen tests should be performed to identify the aetiology of the gap rise and proper therapy should be administered.
血清渗透压间隙的测量是疑似有毒酒精摄入时的一项有用工具。正常的渗透压间隙水平通常<10 mOsm/kg）。渗透压间隙>20 mOsm/kg通常是由摄入甲醇、乙二醇、异丙醇、丙二醇、二甘醇或有机溶剂（如丙酮）引起的，但单独由乙醇引起的情况很少见。在此，我们描述了一例严重乙醇中毒患者，其渗透压间隙显著增加。一名18岁男性在暴饮后昏迷，被转诊至我院急诊科。血气分析显示高阴离子间隙代谢性酸中毒。此外，还发现其渗透压间隙极高，达91 mOsm/kg。渗透压间隙的增加和高阴离子间隙酸中毒不能归因于甲醇/乙二醇中毒、酒精性酮症酸中毒或其他酸中毒原因。计算得出的乙醇渗透压浓度为91 mOsm/kg（乙醇的渗透压浓度等于血清乙醇水平（mg/dL）除以3.7）。因此，渗透压间隙的增加完全是乙醇中毒的结果。急性、单纯的乙醇中毒可能是导致渗透压间隙显著增加并伴有高阴离子间隙代谢性酸中毒的罕见原因。临床医生应警惕在出现高阴离子间隙代谢性酸中毒和渗透压间隙极高的患者中存在急性乙醇中毒的可能性。应进行毒理学筛查试验以确定间隙升高的病因，并给予适当治疗。
