Survey of ethanol assay availability in the UK: Can we cope with ethylene glycol/methanol poisoning?

• Published in: Clinical toxicology (Philadelphia, Pa.) Pa.), 2005-10, Vol.43 (6), p.742-742
• Main Authors: Shiew, C M, Dargan, P I, Greene, S L, Jones, AL
• Format: Article
• Language: English
• ISSN: 1556-3650

Intravenous ethanol is the recommended antidote for ethylene glycol and methanol poisoning in the United Kingdom (UK). Variable ethanol pharmacokinetics mean frequent serum ethanol measurements are crucial for effective treatment. Recent US Academy of Biochemistry guidelines recommend a turnaround time for serum ethanol measurement of 1 hour or less (UK guidelines within 2 hours). Serum ethanol measurement is also important in determination of the osmolal gap. We aimed to assess availabiliy of routine serum ethanol assays in UK laboratories. A postal questionaire survey was sent to 193 acute biochemistry laboratories in the UK (February 2005) asking if routine serum ethanol assays were available 24 hours a day. Routine assay was defined as an assay done by a resident technician without factors causing possible delay (the need for off-site personnel, case discussion with a biochemist, or transport of the sample elsewhere for analysis). If routine assays were not available 24/7, laboratories were asked to specify alternative arrangements. We also asked what units were used to report ethanol concentrations. Non-responders were sent another survey form after 4 weeks. Information has currently been returned by 127 laboratories. Ethanol assays are available routinely 24/7 in 84 laboratories (66% of respondents). Of the 43 laboratories (34% of respondents) where ethanol assays are not routinely available: 16 require discussion with an on-call biochemist, 3 require a biochemist to travel to the laboratory, 17 send the sample to another laboratory, 5 have no alternative arrangements. The last 3 categories (22% of respondents) are unlikely to be able to determine a serum ethanol concentration within 2 hours. There was considerable variance in the units used for reporting: mg/dl (67%), mg/L (16%), mmol/L (9%), g/L (5%), mg% (0.1%). A significant number of UK laboratories are unable to provide serum ethanol concentrations within 2 hours which may lead to delays in diagnosis and effective treatment of methanol or ethylene glycol poisoning. The variable units used to report serum ethanol concentrations are a potential source or error.