Serum osmolal gap in clinical practice: usefulness and limitations

References

• Horinek EL, Kiser TH, Fish DN, et al. Propylene glycol accumulation in critically ill patients receiving continuous intravenous lorazepam infusions. Ann Pharmacother. 2009;43:1964–1971.
   PubMed Web of Science ®Google Scholar
• Kim S, Sung J, Kang WC, et al. Increased plasma osmolar gap is predictive of contrast-induced acute kidney injury. Tohoku J Exp Med. 2012;228:109–117.
   PubMed Web of Science ®Google Scholar
• Heavens KR, Kenefick RW, Caruso EM, et al. Validation of equations used to predict plasma osmolality in a healthy adult cohort. Am J Clin Nutr. 2014;100:1252–1256.
   PubMed Web of Science ®Google Scholar
• Martin-Calderon JL, Bustos F, Tuesta-Reina LR, et al. Choice of the best equation for plasma osmolality calculation: comparison of fourteen formulae. Clin Biochem. 2015;48:529–533.
   PubMed Web of Science ®Google Scholar
• Garrard A, Sollee DR, Butterfield RC, et al. Validation of a pre-existing formula to calculate the contribution of ethanol to the osmolar gap. Clin Toxicol (Phila). 2012;50:562–566.
   PubMed Web of Science ®Google Scholar
• Whittington JE, La’ulu SL, Hunsaker JJ, et al. The osmolal gap: what has changed? Clin Chem. 2010;56:1353–1355.
   PubMed Web of Science ®Google Scholar
• Krahn J, Khajuria A. Osmolality gaps: diagnostic accuracy and long-term variability. Clin Chem. 2006;52:737–739.
   PubMed Web of Science ®Google Scholar
• Glaser DS. Utility of the serum osmol gap in the diagnosis of methanol or ethylene glycol ingestion. Ann Emerg Med. 1996;27:343–346.
   PubMed Web of Science ®Google Scholar
• Kraut JA, Kurtz I. Toxic alcohol ingestions: clinical features, diagnosis, and management. Clin J Am Soc Nephrol. 2008;3:208–225.
   PubMed Web of Science ®Google Scholar
• Walker JA, Schwartzbard A, Krauss EA, et al. The missing gap. A pitfall in the diagnosis of alcohol intoxication by osmometry. Arch Intern Med. 1986;146:1843–1844.
   PubMedGoogle Scholar
• Berend K, De Vries AP, Gans RO. Physiological approach to assessment of acid-base disturbances. N Engl J Med. 2014;371:1434–1445.
   PubMed Web of Science ®Google Scholar
• Rothberger GD, Desai AK, Sharif S, et al. The case: elevated lactate and osmolar gap after levothyroxine overdose. Kidney Int. 2015;88:419–420.
   PubMed Web of Science ®Google Scholar
• Sood MM, Richardson R. Negative anion gap and elevated osmolar gap due to lithium overdose. Cmaj. 2007;176:921–923.
   PubMed Web of Science ®Google Scholar
• Liamis G, Liberopoulos E, Barkas F, et al. Spurious electrolyte disorders: a diagnostic challenge for clinicians. Am J Nephrol. 2013;38:50–57.
   PubMed Web of Science ®Google Scholar
• Gatselis NK, Liamis G, Makaritsis KP, et al. Metabolic acidosis during treatment of mushroom poisoning: a diagnostic pitfall. Intern Med. 2012;51:1077–1080.
   PubMed Web of Science ®Google Scholar
• Krasowski MD, Wilcoxon RM, Miron J. A retrospective analysis of glycol and toxic alcohol ingestion: utility of anion and osmolal gaps. BMC Clin Pathol. 2012;12:1.
   PubMedGoogle Scholar
• Kraut JA, Xing SX. Approach to the evaluation of a patient with an increased serum osmolal gap and high-anion-gap metabolic acidosis. Am J Kidney Dis. 2011;58:480–484.
   PubMed Web of Science ®Google Scholar
• Mycyk MB, Aks SE. A visual schematic for clarifying the temporal relationship between the anion and osmol gaps in toxic alcohol poisoning. Am J Emerg Med. 2003;21:333–335.
   PubMed Web of Science ®Google Scholar
• Schelling JR, Howard RL, Winter SD, et al. Increased osmolal gap in alcoholic ketoacidosis and lactic acidosis. Ann Intern Med. 1990;113:580–582.
   PubMed Web of Science ®Google Scholar
• Owen OE, Trapp VE, Skutches CL, et al. Acetone metabolism during diabetic ketoacidosis. Diabetes. 1982;31:242–248.
   PubMed Web of Science ®Google Scholar
• Ku E, Cheung EL, Khan A, et al. Anion and osmolal gaps after alcohol intoxication. Am J Kidney Dis. 2009;54:385–388.
   PubMed Web of Science ®Google Scholar
• Shahangian S, Ash KO. Formic and lactic acidosis in a fatal case of methanol intoxication. Clin Chem. 1986;32:395–397.
   PubMed Web of Science ®Google Scholar
• Hovda KE, Hunderi OH, Rudberg N, et al. Anion and osmolal gaps in the diagnosis of methanol poisoning: clinical study in 28 patients. Intensive Care Med. 2004;30:1842–1846.
   PubMed Web of Science ®Google Scholar
• Barceloux DG, Krenzelok EP, Olson K, et al. American academy of clinical toxicology practice guidelines on the treatment of ethylene glycol poisoning. J Toxicol Clin Toxicol. 1999;37:537–560.
   PubMed Web of Science ®Google Scholar
• Gabow PA, Clay K, Sullivan JB, et al. Organic acids in ethylene glycol intoxication. Ann Intern Med. 1986;105:16–20.
   PubMed Web of Science ®Google Scholar
• Morgan TJ, Clark C, Clague A. Artifactual elevation of measured plasma L-lactate concentration in the presence of glycolate. Crit Care Med. 1999;27:2177–2179.
   PubMed Web of Science ®Google Scholar
• Chaudhry SD, Pandurangan M, Pinnell AE. Lactate gap and ethylene glycol poisoning. Eur J Anaesthesiol. 2008;25:511–513.
   PubMed Web of Science ®Google Scholar
• Verelst S, Vermeersch P, Desmet K. Ethylene glycol poisoning presenting with a falsely elevated lactate level. Clin Toxicol (Phila). 2009;47:236–238.
   PubMed Web of Science ®Google Scholar
• Pernet P, Beneteau-Burnat B, Vaubourdolle M, et al. False elevation of blood lactate reveals ethylene glycol poisoning. Am J Emerg Med. 2009;27(132):e1–2.
   Google Scholar
• Sandberg Y, Rood PP, Russcher H, et al. Falsely elevated lactate in severe ethylene glycol intoxication. Neth J Med. 2010;68:320–323.
   PubMed Web of Science ®Google Scholar
• Woo MY, Greenway DC, Nadler SP, et al. Artifactual elevation of lactate in ethylene glycol poisoning. J Emerg Med. 2003;25:289–293.
   PubMed Web of Science ®Google Scholar
• Oostvogels R, Kemperman H, Hubeek I, ter Braak EW. The importance of the osmolality gap in ethylene glycol intoxication. Bmj. 2013;347:f6904.
   Google Scholar
• Fijen JW, Kemperman H, Ververs FF, et al. False hyperlactatemia in ethylene glycol poisoning. Intensive Care Med. 2006;32:626–627.
   PubMed Web of Science ®Google Scholar
• Riquier T, Geri G, Mongardon N, et al. False hyperlactatemia in life-threatening ethylene glycol poisoning. Ann Fr Anesth Reanim. 2014;33:e79–81.
   Google Scholar
• Brindley PG, Butler MS, Cembrowski G, et al. Falsely elevated point-of-care lactate measurement after ingestion of ethylene glycol. Cmaj. 2007;176:1097–1099.
   PubMed Web of Science ®Google Scholar
• Head JM. Ethylene glycol ingestion masked by concomitant ethanol intoxication. BMJ Case Rep. 2012;2012. DOI:10.1136/bcr.12.2011.5326
   PubMedGoogle Scholar
• Davidson DF. Excess osmolal gap in diabetic ketoacidosis explained. Clin Chem. 1992;38:755–757.
   PubMed Web of Science ®Google Scholar
• Braden GL, Strayhorn CH, Germain MJ, et al. Increased osmolal gap in alcoholic acidosis. Arch Intern Med. 1993;153:2377–2380.
   PubMed Web of Science ®Google Scholar
• Hunderi OH, Hovda KE, Jacobsen D. Use of the osmolal gap to guide the start and duration of dialysis in methanol poisoning. Scand J Urol Nephrol. 2006;40:70–74.
   PubMedGoogle Scholar
• Brent J. Fomepizole for ethylene glycol and methanol poisoning. N Engl J Med. 2009;360:2216–2223.
   PubMed Web of Science ®Google Scholar