False elevation of blood lactate reveals ethylene glycol poisoning

Ethylene glycol poisoning is a medical emergency. Making a definitive diagnosis is challenging because few institutions have timely access to direct measurement of ethylene glycol. After ingestion, primary metabolism of ethylene glycol takes place in the liver, leading to glycolic acid and glyoxylic...

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Bibliographic Details
Published in:The American journal of emergency medicine 2009, Vol.27 (1), p.132.e1-132.e2
Main Authors: Pernet, Pascal, PhD, Bénéteau-Burnat, Bénédicte, PhD, Vaubourdolle, Michel, PhD, Maury, Eric, MD, Offenstadt, Georges, MD
Format: Article
Language:English
Subjects:
Acidosis, Lactic - blood
Alcohols - blood
Alcohols - poisoning
Blood Gas Analysis
Chemical industry
Dehydrogenase
Emergency
Emergency medical care
Ethylene Glycol - blood
Ethylene Glycol - poisoning
Humans
Lactic Acid - blood
Male
Medical diagnosis
Metabolites
Middle Aged
Oxalic acid
Poisoning
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Summary:Ethylene glycol poisoning is a medical emergency. Making a definitive diagnosis is challenging because few institutions have timely access to direct measurement of ethylene glycol. After ingestion, primary metabolism of ethylene glycol takes place in the liver, leading to glycolic acid and glyoxylic acid. These compounds may cross-react with L-lactate oxidase used in blood gas analyzers lactate electrodes to induce false elevation of blood lactate. We present the case of a 47-year-old male patient initially admitted to the intensive care unit for severe lactate acidosis of unknown cause (pH 6.96, lactate, 30 mmol/L). Knowledge of potent artifactual lactate results was the key to the diagnosis of ethylene glycol poisoning, and false lactate measurements were found at the central laboratory on our 3 different blood gas analyzers.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2008.04.029