Lactate Gap: A Diagnostic Support in Severe Metabolic Acidosis of Unknown Origin

Case Reports in Medicine
Linn E HauvikErik W Nielsen

Abstract

Ethylene glycol poisoning is a medical emergency. The metabolites glycolate and glyoxylate give metabolic acidosis. Because of similar structure, these metabolites are misinterpreted as lactate by many point-of-care blood gas analyzers. The falsely high lactate values can lead to misdiagnosis, inappropriate laparotomies, and delayed antidotal therapy. As laboratory analyzers measure plasma lactate only, the difference or the "lactate gap" aids in early diagnosis. We present a patient with severe metabolic acidosis and elevated lactate levels on the point-of-care analyzer. A lactate gap supported the diagnosis of ethylene glycol poisoning. Hemodialysis and fomepizole treatment could be started immediately.

References

Oct 31, 2003·The Journal of Emergency Medicine·Michael Y WooPierre Cardinal
Apr 11, 2007·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Peter G BrindleyDavid N Brindley
Dec 12, 2007·Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology·Larissa I VelezDaniel C Keyes
Dec 2, 2008·The American Journal of Emergency Medicine·Pascal PernetGeorges Offenstadt
Nov 7, 2012·Annals of Clinical Biochemistry·Andrei TintuHenk Russcher
Dec 12, 2013·Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række·Magnus SalomonsenErik Waage Nielsen

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Citations

Nov 19, 2019·Biomarkers : Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals·Alexander ReisingerGerald Hackl
Feb 12, 2021·BMJ Case Reports·Laurence Poirier-BlanchetteBlair Carl Schwartz

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