A 15‐year‐old girl presented to the pediatric emergency department after being euphoric and increasingly confused at home. Her past medical history was unremarkable. On admission she was afebrile and drowsy and Glasgow coma scale score was fluctuating, but she remained verbal. Cardiovascular examination was unremarkable and she looked well perfused. Respiratory rate was 35 breaths/min and oxygen saturation was 99% in ambient air. Laboratory data were as follows: serum sodium, 145 mmol/L; serum potassium, 5.2 mmol/L; serum chloride, 111 mmol/L; serum osmolality, 306 mOsm/kg; and serum creatinine, 97 μmol/L (up from 70 μmol/L 1 month prior). Arterial blood gas analysis indicated metabolic acidosis (pH, 7.20; partial pressure of carbon dioxide [pCO2], 8 mm Hg; bicarbonate, 3.4 mmol/L; base excess, −23.4) with an elevated anion gap (calculated at 30.6 mmol/L) and elevated lactate at 28.4 mmol/L (Table ). The calculated osmolality was 303.9 mOsm/kg, thus no osmolar gap was present. Brain and chest imaging were normal, as was electrocardiography. Routine toxicology screen for benzodiazepines, opioids, amphetamines, tetrahydrocannabinol, tricyclic antidepressants and ethanol was negative. Urine microscopy, however, indicated massive crystalluria. Volume expansion with saline and bicarbonate was carried out. The presence of high anion‐gap metabolic acidosis, altered mental status and acute kidney injury was highly suggestive of toxic alcohol ingestion. Given the negative ethanol screen and
Pediatrics International – Wiley
Published: Jan 1, 2018
Keywords: ; ; ;
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