Jeffrey Brent, M.D., Ph.D. Volume 360:2216-2223 May 21, 2009 Number 21
A 35-year-old man is brought to the emergency department by his wife after ingesting automobile antifreeze in an attempt at self-harm. On presentation, the patient is somnolent. He is afebrile and has a blood pressure of 126/72 mm Hg, a pulse rate of 102 beats per minute, and a respiratory rate of 24 breaths per minute. Pulse oximetry shows a hemoglobin saturation of 97% while the patient is breathing ambient air. His physical examination is normal except for tachypnea. His serum electrolyte profile and creatinine level are normal except for a serum carbon dioxide level of 17 mmol per liter. Arterial blood gas measurement reveals a pH of 7.30. Urinalysis shows microscopic hematuria and needle-shaped crystals typical of calcium oxalate. The patient’s calculated serum osmolarity is 308 mOsm per liter, and his measured serum osmolality 395 mOsm per kilogram. A medical toxicologist recommends treatment with fomepizole. Subsequently, the patient’s serum ethylene glycol concentration is determined to be 580 mg per deciliter (93.4 mmol per liter).
Also Click Read More to see the presentation by Dr Christina YS CHAN (PMH) on this similar topic.
Go the NEJM here.
See Dr Christina YS Chan’s presentation here.