Ammar K A, Heckerling P S
Department of Medicine, University of Illinois at Chicago 60612, USA.
Am J Kidney Dis. 1996 Jan;27(1):130-3. doi: 10.1016/s0272-6386(96)90040-2.
Ethylene glycol poisoning classically presents as a metabolic acidosis with an increased anion gap. Metabolism of ethylene glycol to organic acids, and increased production of lactate, are responsible for the increased gap. We report the case of an alcohol user who consumed ethanol and ethylene glycol concurrently, and presented without acidosis, with a normal anion gap. Several hours later, when his serum ethanol level had declined, he developed severe acidosis with an elevated anion gap. An increased osmolal gap, not accounted for by the serum ethanol level, proved to be an important clue to the diagnosis. In this patient, ingestion of ethanol inhibited the hepatic metabolism of ethylene glycol to organic acids, obscuring the diagnosis. In intoxicated alcohol users, even in the absence of metabolic acidosis, serum osmolality measurements and calculation of the osmolal gap may facilitate the rapid diagnosis of ethylene glycol poisoning.
乙二醇中毒典型表现为伴有阴离子间隙增大的代谢性酸中毒。乙二醇代谢为有机酸以及乳酸生成增加，导致了阴离子间隙增大。我们报告一例酒精使用者，其同时摄入了乙醇和乙二醇，就诊时无酸中毒表现，阴离子间隙正常。数小时后，当他的血清乙醇水平下降时，出现了伴有阴离子间隙升高的严重酸中毒。血清乙醇水平无法解释的渗透压间隙增大被证明是诊断的重要线索。在该患者中，乙醇的摄入抑制了乙二醇向有机酸的肝脏代谢，从而掩盖了诊断。在酒精中毒的使用者中，即使没有代谢性酸中毒，测定血清渗透压和计算渗透压间隙也可能有助于快速诊断乙二醇中毒。
