Falsely elevated point-of-care lactate measurement after ingestion of ethylene glycol

Brindley, Peter G.; Butler, Matthew S.; Cembrowski, George; Brindley, David N.
April 2007
CMAJ: Canadian Medical Association Journal;4/10/2007, Vol. 176 Issue 8, p1097
Academic Journal
Background: A patient presented with severe acidosis and a point-of-care lactate measurement of 42 mmol/L. Mesenteric ischemia was suspected, with a potential need for laparotomy; however, plasma lactate measurements were below 4 mmol/L. Ethylene glycol ingestion was subsequently diagnosed. We therefore wished to determine why discrepancies in lactate measurements occur and whether this "lactate gap" could be clinically useful. Methods: We phlebotomized blood, added various concentrations of metabolites of ethylene glycol, and tested the resulting samples with the 5 most common lactate analyzers. Results: With the Radiometer 700 point-of-care analyzer, glycolate addition resulted in an artifactual, massive lactate elevation, even at low glycolate concentrations. Another major ethylene glycol metabolite, glyoxylate (but not oxalate or formate), caused similar elevations. The i-STAT and Bayer point-of-care analyzers and the Beckman and Vitros laboratory analyzers reported minimal lactate elevations. Lactate gap was determined by comparing the Radiometer result with the corresponding result from any of the other analyzers. Interpretation: We demonstrated how inappropriate laparotomy or delayed therapy might occur if clinicians are unaware of this phenomenon or have access to only a single analyzer. We also showed that lactate gap can be exploited to expedite treatment, diagnose late ethylene-glycol ingestion and terminate dialysis. By comparing lactate results from the iSTAT or Bayer devices with that from the Radiometer, ethylene-glycol ingestion can be diagnosed at the point of care. This can expedite diagnosis and treatment by hours, compared with waiting for laboratory results for plasma ethylene glycol.


Related Articles

  • Ethylene glycol poisoning: a rare but life-threatening cause of metabolic acidosis—a single-centre experience. Latus, Joerg; Kimmel, Martin; Alscher, Mark Dominik; Braun, Niko // Clinical Kidney Journal;Apr2012, Vol. 5 Issue 2, p120 

    Background. Intoxication with ethylene glycol happen all around the world and without rapid recognition and early treatment, mortality from this is high. Methods. In our study, we retrospectively analysed six cases of ethylene glycol intoxication in our department. We measured ethylene glycol or...

  • Ethylene glycol toxicity associated with ischemia, perforation, and colonic oxalate crystal deposition. Gardner, Timothy B; Manning, Harold L; Beelen, Andrew; Cimis, Robert J; Cates, Justin M M; Lewis, Lionel D // American Journal of Gastroenterology;Sep2003 Supplement, Vol. 98, pS171 

    An abstract of the article "Ethylene Glycol Toxicity Associated With Ischemia, Perforation, and Colonic Oxalate Crystal Deposition," by Timothy B. Gardner, Harold L. Manning, Andrew Beelen, Robert J. Cimis, Justin M. M. Cates, and Lionel D. Lewis is presented.

  • Intracellular Ca2+ Modulation during Short Exposure to Ischemia-Mimetic Factors in Isolated Rat Ventricular Myocytes. Pravdić, Danijel; Vladić, Nikolina; Bošnjak, Željko Josip // Collegium Antropologicum;2009 Supplement 2, Vol. 33, p121 

    We investigated the effects of different ischemia-mimetic factors on intracellular Ca2+ concentration ([Ca2+i). Ventricular myocytes were isolated from adult Wistar rats, and [Ca2+]i was measured asing fluorescent indicator fluo-4 AM by confocal miclvscopy. Intracellular pH was measured using...

  • Ethylene glycol developmental toxicity: unraveling the roles of glycolic acid and metabolic acidosis. Carney, E. W.; Freshour, N. L.; Dittenber, D. A.; Dryzga, M. D. // Toxicological Sciences;Jul1999, Vol. 50 Issue 1, p117 

    This study sought to determine the relative roles of glycolic acid (GA), a toxicologically important metabolite of ethylene glycol (EG), and metabolic acidosis in causing developmental toxicity in Sprague-Dawley rats. To tease apart these two interrelated factors, we developed an experimental...

  • Interference of ethylene glycol with L-lactate measurement is assay-dependent. Tintu, Andrei; Rouwet, Ellen; Russcher, Henk // Annals of Clinical Biochemistry;Jan2013, Vol. 50 Issue 1, p70 

    Background: Metabolites of ethylene glycol (EG) can cross-react in L-lactate assays, leading to falsely elevated serum lactate levels in case of EG intoxication. In this study, we evaluated the effects of EG and its metabolites on routinely used lactate measuring methods. Methods: Serum aliquots...

  • The Case | Elevated lactate and osmolar gap after levothyroxine overdose. Rothberger, Gary D; K Desai, Anish; Sharif, Sairah; A Chawla, Shalinee; Shirazian, Shayan // Kidney International;Aug2015, Vol. 88 Issue 2, p419 

    The article presents a case study of a 42-year-old woman who was suffering from hypothyroidism. It mentions that the woman has been diagnosed with ethylene glycol toxicity after a urine microscopy. Mentioned is the toxic metabolites with fomepizole as well as the elevation of arterial lactate...

  • Polyethylene glycol modification decreases the cardiac toxicity of carbonaceous dots in mouse and zebrafish models. Chen, Jian-tao; Sun, Hua-qin; Wang, Wei-liang; Xu, Wen-ming; He, Qin; Shen, Shun; Qian, Jun; Gao, Hui-le // Acta Pharmacologica Sinica;Nov2015, Vol. 36 Issue 11, p1349 

    Aim:Carbonaceous dots (CDs), which have been used for diagnosis, drug delivery and gene delivery, are accumulated in heart at high concentrations. To improve their biocompatibility, polyethylene glycol-modified CDs (PEG-CDs) were prepared. In this study we compared the cardiac toxicity of CDs...

  • Mesenteric Revascularization in a Contaminated Abdomen: A Case Report. Young, Richard M.; Hoballah, Jamal J.; Sharp, William J.; Corson, John D. // Vascular Surgery;Sep/Oct2001, Vol. 35 Issue 5, p415 

    Presents a case of a woman with mesenteric revascularization in the contaminated abdomen. Use of saphenous vein in a non-reversed orientation; Replacement of the aneurysmal aspect of vein bypass with polytetrafluoroethylene interposition graft; Symptoms of mesenteric ischemia.

  • Does unintentional ingestion of ethylene glycol represent a serious risk? Křenová, M.; Pelclová, D. // Human & Experimental Toxicology;Jan2007, Vol. 26 Issue 1, p59 

    The objective of this study was to evaluate data retrospectively on accidental ingestion of ethylene glycol (EG), based on calls to the Czech Toxicological Information Centre and from toxicological laboratories, in the years 2000-2004. All patients who ingested a known amount of EG and/or...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics