Paramedics transport a 45-year-old male to the hospital after his wife discovered him confused and stumbling inside their garage. The patient reports severe bilateral flank pain and appears visibly intoxicated, though his wife states he has not consumed alcohol. Vital signs include a temperature of 37.1°C (98.8°F), blood pressure of 145/90 mm Hg, heart rate of 98/min, and respiratory rate of 22/min.
Laboratory evaluation reveals:
| Parameter | Result |
|---|---|
| Serum sodium | 142 mEq/L |
| Serum potassium | 4.8 mEq/L |
| Serum chloride | 102 mEq/L |
| Serum bicarbonate | 12 mEq/L |
| Blood urea nitrogen | 28 mg/dL |
| Serum creatinine | 1.5 mg/dL |
| Serum glucose | 108 mg/dL |
| Serum ethanol | Undetectable |
| Measured serum osmolality | 335 mOsm/kg H₂O |
Based on the provided laboratory data, determine this patient's serum osmolar gap in mOsm/kg H₂O.
Answer: 35 mOsm/kg H₂O
Answer
35
The patient's osmolar gap is 35 mOsm/kg H₂O. When combined with a significant metabolic acidosis (anion gap of 28 mEq/L) and flank pain, this elevated osmolar gap is highly characteristic of ethylene glycol toxicity, likely causing calcium oxalate crystal deposition in the kidneys.
Step-by-Step Solution
Key Concept
Calculation and interpretation of the serum osmolar gap to evaluate for toxic alcohol ingestion.
Estimated Time:1m 0s