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Toxic Alcohols Become Harmful Metabolites
- Toxic alcohols are only harmful when metabolized into toxic acids like formic and glycolic acid.
- Initial symptoms resemble intoxication from the parent alcohol molecules before toxic metabolites accumulate.
Use Anion Gap Over Osmolar Gap
- Monitor serial anion gaps every 2 to 4 hours to detect toxic alcohol metabolism.
- Don't rely solely on osmolar gap as it lacks sensitivity and specificity for screening.
Lactate Gap in Ethylene Glycol
- Portable blood gas lactate meters can falsely elevate lactate readings in ethylene glycol poisoning.
- Glycolic acid metabolite mimics lactic acid, causing a 'lactate gap' between point of care and lab values.