Issn Print: 0163-4356
Publication Date: 1997/10/01
138 STAT ALCOHOL AND ETHYLENE GLYCOL TESTING-PROGRESSIVE TESTING IN CLINICAL PRACTICE
Excerpt
Osmolality and osmolal gap are useful prognostic indicators for low-molecular-weight substances such as alcohols (ethanol, methanol, isopropanol/acetone) and ethylene glycol. Consolidation of stat methanol, isopropanol/acetone, and ethylene glycol analyses at one site within the Capital Health Region and a desire to rationalize this testing led to the development of a progressive testing protocol in consultation with emergency medicine professionals. Prior to processing such stat requests, the following tests must be done: Na, urea, glucose, osmolality and ethanol. The following calculations are performed and reported by the laboratory computer: calculated osmolality, osmolal gap and unaccounted osmolal gap [measured minus (calculated osmolality + ethanol)]. If the unaccounted gap is ≥ 2 mmol/kg for ethylene glycol or ≥ 5 mmol/kg for methanol and isopropanol/acetone test orders, the respective analyses are performed without question. If the unaccounted gap is less than these specified values, further analysis is not performed. Stat requests collected after an initial positive result are excluded from the protocol. A retrospective study using data from a 3 month period prior to implementation of the protocol (all stat requests processed on demand) demonstrated that for all stat methanol and ethylene glycol requests with unaccounted gap values < 2 and < 5 mmol/kg respectively, no treatable concentrations were found. The data also shows that during this period, the protocol would have eliminated 42% and 33% of the stat methanol and ethylene glycol analyses respectively. Therefore, this progressive testing protocol will provide for the safe, effective and rational treatment of methanol and ethylene glycol poisonings.
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