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 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.
Pernet
Pascal
P
Service de Biochimie A, Hôpital St-Antoine, AP-HP, 75571 Paris Cedex 12, France. Electronic address: pascal.pernet@sat.ap-hop-paris.fr.
Bénéteau-Burnat
Bénédicte
B
Service de Biochimie A, Hôpital St-Antoine, AP-HP, 75571 Paris Cedex 12, France.
Vaubourdolle
Michel
M
Service de Biochimie A, Hôpital St-Antoine, AP-HP, 75571 Paris Cedex 12, France.
Maury
Eric
E
Service de Réanimation Médicale, Hôpital St-Antoine, AP-HP, 75571 Paris Cedex 12, France.
Offenstadt
Georges
G
Service de Réanimation Médicale, Hôpital St-Antoine, AP-HP, 75571 Paris Cedex 12, France.
D000140:Acidosis, Lactic / Q000097:blood*; D000438:Alcohols / Q000097:blood / Q000506:poisoning*; D001784:Blood Gas Analysis; D019855:Ethylene Glycol / Q000097:blood / Q000506:poisoning*; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged
D000438:Alcohols; D019344:Lactic Acid; D019855:Ethylene Glycol