title: Falsely elevated lactate in severe ethylene glycol intoxication.
abstract: A 29-year-old male presented at the emergency department of our hospital in a confused state. He had a history of psychoses and substance abuse. Physical examination revealed hyperventilation and abdominal tenderness. Blood gas analysis in the emergency department using an ABL 725 Radiometer analyser showed a severe metabolic acidosis with massive lactate elevation. Lactate acidosis due to mesenteric ischaemia was suspected. However, toxicology screening demonstrated ethylene glycol intoxication. Treatment with ethanol infusion and acute haemodialysis was started. Repeated laboratory measurements using a clinical chemistry analyser showed minimal plasma lactate elevation. Falsely elevated lactate measurement is a little known phenomenon that can occur in ethylene glycol intoxication and can cause serious delay in diagnosis. Therefore, elevated lactate concentrations measured on intensive care unit and emergency department blood gas analysers should be confirmed by a clinical chemistry analyser in the main laboratory in case of suspected ethylene glycol intoxication.
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
authors.forename: Y
authors.initials: Y
authors.lastname: Sandberg
authors.forename: P P M
authors.initials: PP
authors.lastname: Rood
authors.forename: H
authors.initials: H
authors.lastname: Russcher
authors.forename: J J M
authors.initials: JJ
authors.lastname: Zwaans
authors.forename: J D
authors.initials: JD
authors.lastname: Weige
authors.forename: P L A
authors.initials: PL
authors.lastname: van Daele
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D000328:Adult; D001784:Blood Gas Analysis; D003937:Diagnosis, Differential; D000431:Ethanol / Q000627:therapeutic use*; D019855:Ethylene Glycol / Q000506:poisoning*; D005189:False Positive Reactions; D006801:Humans; D019344:Lactic Acid / Q000097:blood* / Q000378:metabolism; D008297:Male; D011618:Psychotic Disorders; D006435:Renal Dialysis; D012997:Solvents / Q000627:therapeutic use*; D019966:Substance-Related Disorders
chemical_list: D012997:Solvents; D019344:Lactic Acid; D000431:Ethanol; D019855:Ethylene Glycol