title: Osmolar gap with minimal acidosis in combined methanol and methyl ethyl ketone ingestion.
abstract: Methyl ethyl ketone is a common solvent but data on overdose in humans are scarce. We report a case of co-ingestion of methyl ethyl ketone together with methanol associated with a hyperosmolar coma without anion gap metabolic acidosis. Blood levels of methyl ethyl ketone and its metabolite, 2-butanol, indicated that this solvent did contribute approximately 20 mosm/L to an observed osmolar gap of 99 mosm/L. At the levels detected, methyl ethyl ketone may have inhibited methanol metabolism, contributing to the low serum formate (1.3 mmol/L) and normal anion gap despite a blood methanol of 67 mmol/L.
authors.affiliation: San Francisco Bay Area Poison Control Center, California.
authors.forename: E A
authors.initials: EA
authors.lastname: Price
authors.forename: A
authors.initials: A
authors.lastname: D'Alessandro
authors.forename: T
authors.initials: T
authors.lastname: Kearney
authors.forename: K R
authors.initials: KR
authors.lastname: Olson
authors.forename: P D
authors.initials: PD
authors.lastname: Blanc
mesh_terms: D000138:Acidosis / Q000139:chemically induced*; D000284:Administration, Oral; D000328:Adult; D002074:Butanones / Q000097:blood / Q000506:poisoning*; D004347:Drug Interactions; D006801:Humans; D008297:Male; D000432:Methanol / Q000097:blood / Q000506:poisoning*; D009994:Osmolar Concentration; D011041:Poisoning / Q000503:physiopathology
chemical_list: D002074:Butanones; C005222:methylethyl ketone; D000432:Methanol