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Lao YE, Heyerdahl F, Jacobsen D, Hovda KE. An enzymatic assay with formate oxidase for point-of-care diagnosis of methanol poisoning. Basic Clin Pharmacol Toxicol 2022; 131:547-554. [PMID: 36083569 PMCID: PMC9825986 DOI: 10.1111/bcpt.13789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/20/2022] [Accepted: 09/06/2022] [Indexed: 01/11/2023]
Abstract
Gas chromatographic analysis for quantification of plasma methanol requires laboratory equipment and personnel, and it is typically unavailable in short time notice, especially in low- and middle-income countries. Detection of formate with the enzyme formate oxidase (FOX) is a promising method that can make the diagnosis of methanol poisoning simple and fast. The aims of this study were to test the sensitivity and specificity of a modified FOX-enzyme and to test the specificity of a point-of-care (POC)-model containing FOX-enzyme with samples from patients with metabolic acidosis. The sensitivity and specificity of FOX-enzyme in aqueous solution were evaluated with a spectrometer and by visual detection for colour change. Formate concentrations between 1 and 20 mmol/L were used to test sensitivity, and 18 potentially interfering substances were tested for specificity. The sensitivity of the FOX-enzyme was 100% and the specificity 97%. When specificity of the POC-model was tested, no false positives were detected. As such, the sensitivity and specificity of this modified FOX-enzyme for detection of formate were high. The results with this enzyme confirm the potential for its use in formate analysis as a fast diagnosis of methanol poisoning.
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Affiliation(s)
- Yvonne Elisabeth Lao
- Norwegian National Unit for CBRNE Medicine, Department of Acute MedicineOslo University HospitalOsloNorway
| | - Fridtjof Heyerdahl
- Air Ambulance DepartmentOslo University HospitalOsloNorway,Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Dag Jacobsen
- Institute of Clinical MedicineUniversity of OsloOsloNorway,Department of Acute MedicineOslo University HospitalOsloNorway
| | - Knut Erik Hovda
- Norwegian National Unit for CBRNE Medicine, Department of Acute MedicineOslo University HospitalOsloNorway
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2
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Hashemi SA, Bahrani S, Mousavi SM, Omidifar N, Arjmand M, Lankarani KB, Shokripour M, Ramakrishna S. Differentiable detection of ethanol/methanol in biological fluids using prompt graphene-based electrochemical nanosensor coupled with catalytic complex of nickel oxide/8-hydroxyquinoline. Anal Chim Acta 2022; 1194:339407. [PMID: 35063153 DOI: 10.1016/j.aca.2021.339407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Seyyed Alireza Hashemi
- Nanomaterials and Polymer Nanocomposites Laboratory, School of Engineering, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Sonia Bahrani
- Health Policy Research Center, Health Institute, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyyed Mojtaba Mousavi
- Department of Chemical Engineering, National Taiwan University of Science and Technology, Taiwan
| | - Navid Omidifar
- Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohammad Arjmand
- Nanomaterials and Polymer Nanocomposites Laboratory, School of Engineering, University of British Columbia, Kelowna, BC, V1V 1V7, Canada.
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Health Institute, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mansoureh Shokripour
- Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seeram Ramakrishna
- Department of Mechanical Engineering, Center for Nanofibers and Nanotechnology, National University of Singapore, Singapore.
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van den Broek J, Bischof D, Derron N, Abegg S, Gerber PA, Güntner AT, Pratsinis SE. Screening Methanol Poisoning with a Portable Breath Detector. Anal Chem 2021; 93:1170-1178. [PMID: 33315383 DOI: 10.1021/acs.analchem.0c04230] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Methanol poisoning outbreaks after consumption of adulterated alcohol frequently overwhelm health care facilities in developing countries. Here, we present how a recently developed low-cost and handheld breath detector can serve as a noninvasive and rapid diagnostic tool for methanol poisoning. The detector combines a separation column and a micromachined chemoresistive gas sensor fully integrated into a device that communicates wirelessly with a smartphone. The performance of the detector is validated with methanol-spiked breath of 20 volunteers (105 breath samples) after consumption of alcoholic beverages. Breath methanol concentrations were quantified accurately within 2 min in the full breath-relevant range (10-1000 ppm) in excellent agreement (R2 = 0.966) with benchtop mass spectrometry. Bland-Altman analysis revealed sufficient limits of agreement (95% confidence intervals), promising to indicate reliably the clinical need for antidote and hemodialysis treatment. This simple-in-use detector features high diagnostic capability for accurate measurement of methanol in spiked breath, promising for rapid screening of methanol poisoning and assessment of severity. It can be applied readily by first responders to distinguish methanol from ethanol poisoning and monitor in real time the subsequent hospital treatment.
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Affiliation(s)
- Jan van den Broek
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, CH-8092 Zurich, Switzerland
| | - Dario Bischof
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, CH-8092 Zurich, Switzerland
| | - Nina Derron
- Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Sebastian Abegg
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, CH-8092 Zurich, Switzerland
| | - Philipp A Gerber
- Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Andreas T Güntner
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, CH-8092 Zurich, Switzerland
| | - Sotiris E Pratsinis
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, CH-8092 Zurich, Switzerland
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Waszkiewicz N, Kratz EM, Chojnowska S, Zalewska A, Zwierz K, Szulc A, Szajda SD, Nestsiarovich A, Kapitau A, Kępka A, Ostrowska L, Ferens-Sieczkowska M. Long-term changes of salivary exoglycosidases and their applicability as chronic alcohol-drinking and dependence markers. World J Biol Psychiatry 2019; 20:64-75. [PMID: 28660791 DOI: 10.1080/15622975.2017.1337221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Investigation of long-term dynamic changes of salivary activity/output of exoglycosidases, deglycosylation processes and their applicability as alcohol markers. METHODS Exoglycosidase (α-fucosidase (FUC), β-galactosidase (GAL), β-glucuronidase (GLU), β-hexosaminidase (HEX, HEX A and HEX B isoenzymes) and α-mannosidase (MAN)) activities were measured in the saliva of healthy social drinking controls (C), alcohol-dependent non-smokers (ANS) and alcohol-dependent smokers (AS) at the 1st, 15th, 30th and 50th day of abstinence after chronic alcohol drinking. RESULTS The activity of exoglycosidases was 2-3-fold (MAN), 2-6 fold (FUC), 8-25-fold (HEX A) and 19-40-fold (GLU) higher in the ANS and AS groups than in controls, and had good/excellent sensitivity, specificity and accuracy. The higher outputs of exoglycosidases were in the AS and ANS groups than in controls at the 1st day (GLU, HEX A) and at the 50th day (GLU, FUC, MAN) of abstinence. We found numerous correlations between alcohol-drinking days with GLU and HEX A, alcohol amounts with HEX A and duration of alcohol dependence with FUC and MAN activity/output. CONCLUSIONS Salivary exoglycosidases/deglycosylation processes were still very high up to 50 days after the end of alcohol consumption. We found markers of chronic alcohol consumption (HEX A), alcohol dependence (FUC and MAN) and chronic alcohol consumption and dependence (GLU).
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Affiliation(s)
- Napoleon Waszkiewicz
- a Department of Psychiatry , Medical University of Białystok , Choroszcz , Poland
| | - Ewa Maria Kratz
- b Chemistry & Immunochemistry Dept , Medical University of Wrocław , Wrocław , Poland
| | - Sylwia Chojnowska
- c Medical Institute , Łomża State University of Applied Sciences , Łomża , Poland
| | - Anna Zalewska
- d Department of Conservative Dentistry , Medical University Białystok , Białystok , Poland
| | - Krzysztof Zwierz
- e Medical Institute of Medical College of the Universal Education Society , Łomża , Poland
| | - Agata Szulc
- f Department of Psychiatry , Medical University of Warsaw , Pruszków , Poland
| | | | - Anastasiya Nestsiarovich
- g The Laboratory of Clinical and Epidemiological Research , Republican Research and Practice Center for Mental Health , Minsk , Belarus
| | - Andrei Kapitau
- h Department of Psychiatry and Psychology , Belarusian State Medical University , Minsk , Belarus
| | - Alina Kępka
- i Department of Biochemistry, Radioimmunology and Experimental Medicine , The Children's Memorial Health Institute , Warsaw , Poland
| | - Lucyna Ostrowska
- j Department of Dietetics and Clinical Nutrition , Medical University, Białystok , Białystok , Poland
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Affiliation(s)
- Jeffrey A Kraut
- From Medical and Research Services and Division of Nephrology, Veterans Health Administration Greater Los Angeles (VHAGLA) Healthcare System, and Membrane Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles - both in Los Angeles (J.A.K.); and the Division of Emergency Medicine, Washington University School of Medicine, St. Louis (M.E.M.)
| | - Michael E Mullins
- From Medical and Research Services and Division of Nephrology, Veterans Health Administration Greater Los Angeles (VHAGLA) Healthcare System, and Membrane Biology Laboratory, David Geffen School of Medicine, University of California, Los Angeles - both in Los Angeles (J.A.K.); and the Division of Emergency Medicine, Washington University School of Medicine, St. Louis (M.E.M.)
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Kraut JA. Approach to the Treatment of Methanol Intoxication. Am J Kidney Dis 2016; 68:161-7. [DOI: 10.1053/j.ajkd.2016.02.058] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/04/2016] [Indexed: 11/11/2022]
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Udagani C, Ramesh TN. Detection and quantitative determination of diethylene glycol in ethyl alcohol using gamma- ray spectroscopy. Journal of Food Science and Technology 2015; 52:5311-6. [PMID: 26243958 DOI: 10.1007/s13197-014-1583-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 09/06/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022]
Abstract
Determination of the toxic diethylene glycol contamination in ethyl alcohol demands a rapid, accurate and reliable method. Diethylene glycol (DEG) ingestion, accidental or intentional, can lead to death. Clinical and analytical methods used to detect diethylene glycol in alcohol require several hours to days due to tedious instrument handling and measurements. Enzymatic assays face difficulty due to analytic problems. As an alternative method of data analysis, we have used γ-ray spectroscopic method to estimate the diethylene glycol contamination in alcohol by monitoring the variation in the linear and mass attenuation coefficients. This method is simple, robust, portable and can provide reliable and quantitative information about the ethyl alcohol adulterated with diethylene glycol which is of broader interest to society.
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Affiliation(s)
- Chikkappa Udagani
- Department of Studies and Research in Physics, Tumkur University, Tumkur, 572 103 India
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Abstract
CONTEXT Methanol, ethylene glycol, diethylene glycol, and propylene glycol intoxications are associated with cellular dysfunction and an increased risk of death. Adverse effects can develop quickly; thus, there is a need for methods for rapidly detecting their presence. OBJECTIVE To examine the value and limitations of present methods to diagnose patients with possible toxic alcohol exposure. METHODS I searched MEDLINE for articles published between 1969 and 2014 using the terms: toxic alcohols, serum osmolality, serum osmol gap, serum anion gap, metabolic acidosis, methanol, ethylene glycol, diethylene glycol, propylene glycol, and fomepizole. Each article was reviewed for additional references. RESULTS The diagnosis of toxic alcohol exposure is often made on the basis of this history and physical findings along with an increase in the serum osmol and anion gaps. However, an increase in the osmol and/or anion gaps is not always present. Definitive detection in blood requires gas or liquid chromatography, laborious and expensive procedures which are not always available. Newer methods including a qualitative colorimetric test for detection of all alcohols or enzymatic tests for a specific alcohol might allow for more rapid diagnosis. CONCLUSIONS Exposure to toxic alcohols is associated with cellular dysfunction and increased risk of death. Treatment, if initiated early, can markedly improve outcome, but present methods of diagnosis including changes in serum osmol and anion gap, and use of gas or liquid chromatography have important limitations. Development of more rapid and effective tests for detection of these intoxications is essential for optimal care of patients.
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Affiliation(s)
- Jeffrey A Kraut
- Medical and Research Services Veterans Administration Greater Los Angeles Healthcare System, UCLA Membrane Biology Laboratory, and Division of Nephrology, Veterans Administration Greater Los Angeles Healthcare System, and David Geffen School of Medicine , Los Angeles , California
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Devoti E, Marta E, Belotti E, Bregoli L, Liut F, Maiorca P, Mazzucotelli V, Cancarini G. Diethylene glycol poisoning from transcutaneous absorption. Am J Kidney Dis 2014; 65:603-6. [PMID: 25445099 DOI: 10.1053/j.ajkd.2014.07.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/09/2014] [Indexed: 11/11/2022]
Abstract
A case of transcutaneous diethylene glycol poisoning with severe acute kidney injury, but a positive outcome, is described. A man without significant medical history was admitted to our hospital due to anuria, gastrointestinal symptoms, and hypertension. Ultrasonography excluded vascular damage and postrenal obstruction. Laboratory tests showed acute kidney injury and metabolic acidosis with increased anion gap; hemodialysis therapy was started. The brother of the patient reported that the patient had been smearing his skin with brake fluid containing diethylene glycol to treat a "dermatitis." Only supportive therapy was given due to the lack of a specific antidote. Continuous venovenous hemofiltration was performed. The kidney biopsy showed acute toxic proximal tubulonecrosis, without deposition of oxalate crystals. His neurologic condition worsened dramatically; supportive care was continued. Over time, acute kidney injury and neurologic damage gradually improved; 33 days after admission, he went to a rehabilitation unit for 5 months, with complete clinical recovery. Historically, diethylene glycol has been the cause of large-scale poisonings from ingestion of contaminated drugs. The clinical evolution is unpredictable. Treatment is not well defined; early hemodialysis treatment reduces levels of toxic metabolites, and fomepizole could be useful in cases with an early diagnosis. A comparison of the characteristics of diethylene glycol versus ethylene glycol poisoning is given.
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Affiliation(s)
- Elisabetta Devoti
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy.
| | - Elisabetta Marta
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Elena Belotti
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Laura Bregoli
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Francesca Liut
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Paolo Maiorca
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Valentina Mazzucotelli
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Giovanni Cancarini
- Operative Unit of Nephrology, A.O. Spedali Civili di Brescia and University of Brescia, Brescia, Italy
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Waszkiewicz N, Chojnowska S, Zalewska A, Zwierz K, Szulc A, Szajda SD. Salivary Exoglycosidases as Markers of Alcohol Dependence. Alcohol Alcohol 2014; 49:409-16. [DOI: 10.1093/alcalc/agu005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McQuade DJ, Dargan PI, Wood DM. Challenges in the diagnosis of ethylene glycol poisoning. Ann Clin Biochem 2013; 51:167-78. [DOI: 10.1177/0004563213506697] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ethylene glycol poisoning, while uncommon, is clinically significant due to the associated risk of severe morbidity or lethality and it continues to occur in many countries around the world. The clinical presentation of ethylene glycol toxicity, while classically described in three phases, varies widely and when combined with the range of differential diagnoses that must be considered makes diagnosis challenging. Early and accurate detection is important in these patients, however, as there is a need to start antidotal treatment early to prevent serious harm. In this article, we will review the literature and provide guidance regarding the diagnosis of ethylene glycol poisoning. While gas chromatography is the gold standard, the usefulness of this test is hampered by delays in access due to availability. Consequently, there are several surrogate markers that can give an indication of ethylene glycol exposure but these must be interpreted with caution and within the clinical context. An in-depth review of these tests, particularly the detection of a raised osmolar gap or an raised anion gap acidosis, will form the main focus of this article.
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Affiliation(s)
- David J McQuade
- Emergency Department, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
| | - Paul I Dargan
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
- King’s College London, London, UK
| | - David M Wood
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
- King’s College London, London, UK
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Waszkiewicz N, Chojnowska S, Zalewska A, Zwierz K, Szulc A, Szajda SD. Salivary hexosaminidase in smoking alcoholics with bad periodontal and dental states. Drug Alcohol Depend 2013; 129:33-40. [PMID: 23026815 DOI: 10.1016/j.drugalcdep.2012.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 09/08/2012] [Accepted: 09/09/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND A sensitive alcohol marker, β-hexosaminidase (HEX), in the saliva of alcoholics, is investigated for the first time. METHODS The activity, specific-activity and output of total HEX and its isoenzymes HEX A and HEX B were measured in the saliva of healthy controls (C), alcohol-dependent non-smokers (ANS), and alcohol-dependent smokers (AS). RESULTS We observed a significantly increased activity/specific-activity and output of HEX A in the ANS and AS groups, due to the inflammatory state of the oral-cavity/salivary-glands. Significantly increased activity of HEX A contributed to an increase in the salivary activity of the total HEX in the ANS group. A significant decrease in the activity/specific-activity of HEX B in AS seemed to be due to HEX B inactivation by cigarette smoke. We noticed a tendency for deteriorated dental state (lower decayed-missing-filled-teeth index - DMFT), worse periodontal state (higher gingival index - GI and papilla-bleeding index - PBI) in AS, and worse periodontal state (higher GI) in ANS, as compared to the controls. We found no differences in the salivary protein concentrations between all groups and decreased salivary flow in both alcoholic groups as compared to the controls. In alcoholics, the area under the curve (AUC) for HEX A activity/specific-activity was significantly greater than for HEX and HEX B. The salivary HEX A activity/specific-activity had good/excellent sensitivity and specificity in smoking and non-smoking alcoholics, whereas salivary HEX and HEX B had poor/fair sensitivity and specificity. CONCLUSIONS Salivary HEX A may be helpful in the diagnosis of chronic alcohol intoxication, even in smokers.
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Affiliation(s)
- Napoleon Waszkiewicz
- Department of Psychiatry, Medical University of Białystok, ul. Plac Brodowicza 1, 16-070 Choroszcz, Poland.
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Porter WH. Ethylene glycol poisoning: quintessential clinical toxicology; analytical conundrum. Clin Chim Acta 2011; 413:365-77. [PMID: 22085425 DOI: 10.1016/j.cca.2011.10.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 10/21/2011] [Accepted: 10/25/2011] [Indexed: 12/20/2022]
Abstract
Ethylene glycol poisoning is a medical emergency that presents challenges both for clinicians and clinical laboratories. Untreated, it may cause morbidly or death, but effective therapy is available, if administered timely. However, the diagnosis of ethylene glycol poisoning is not always straightforward. Thus, measurement of serum ethylene glycol, and ideally glycolic acid, its major toxic metabolite in serum, is definitive. Yet measurement of these structurally rather simple compounds is but simple. This review encompasses an assessment of analytical methods for the analytes relevant for the diagnosis and prognosis of ethylene glycol poisoning and of the role of the ethylene glycol metabolites, glycolic and oxalic acids, in its toxicity.
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Affiliation(s)
- William H Porter
- Department of Pathology and Laboratory Medicine, University of Kentucky Medical Center, Lexington, KY, United States.
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Kraut JA. Commentary. Clin Chem 2011; 57:1364-5. [DOI: 10.1373/clinchem.2011.164103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jeffrey A Kraut
- Medical and Research Services, Veterans Health Administration Greater Los Angeles (VHAGLA) Healthcare System
- UCLA Membrane Biology Laboratory
- Division of Nephrology, VHAGLA Healthcare System, and
- David Geffen School of Medicine, Los Angeles, CA
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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; 58:480-4. [DOI: 10.1053/j.ajkd.2011.05.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 05/16/2011] [Indexed: 11/11/2022]
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Schep LJ, Slaughter RJ, Temple WA, Beasley DMG. Diethylene glycol poisoning. Clin Toxicol (Phila) 2009; 47:525-35. [PMID: 19586352 DOI: 10.1080/15563650903086444] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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