What is the role of lab tests in the workup of ethylene glycol alcohol toxicity?

Updated: Jan 05, 2021
  • Author: Michael D Levine, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

A serum ethylene glycol level should be obtained when this diagnosis is suspected. The osmolar gap and anion gap should also be obtained. After correcting for other variables, including ethanol, the serum ethylene glycol level can be estimated by multiplying the remaining osmolar gap by 6.2.

A baseline creatinine and BUN level should be obtained in all cases of ethylene glycol intoxication. These values can then be followed to check for the development of renal failure.

In addition, the urine can be examined for evidence of fluorescence. In antifreeze, fluorescein is added to the liquid to permit mechanics to identify the source of a fluid leaking from a car. However, fluorescein is excreted in the urine faster than ethylene glycol. Thus, fluorescence can be eliminated before the patient even arrives in the emergency department. As such, the presence of fluorescence of urine under a Wood's lamp is not a sensitive test. In addition, because certain containers themselves fluoresce, the presence of fluorescence is neither sensitive nor specific. Despite this, a positive test that differentiates urine fluorescence from that of its container may be a quick bedside clue pointing toward ethylene glycol intoxication.

Both a serum calcium level and an electrocardiogram should be obtained, since hypocalcemia may occur as calcium combines with oxalate in the form of calcium oxalate crystals. [23]


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