|Downtime form:||A-1a Doctor/Provider Orders - Pathology Core and Specialty Care Nursery|
|Plasma Separator Tube 4.5 mL|
None detected. Ethanol intoxication begins in the 50-100 mg/dL range. Critical value: >300 mg/dL
Samples with unexplained osmolar gap greater than 15 have "Ethylene glycol, plasma" (by immunoassay) run reflexively. For those samples, if the ethylene glycol plasma concentration does not account for the high osmolar gap, the pathology resident on-call is contacted. The resident will then investigate the case and contact the clinical service, if indicated. Elevated osmolar gaps may also be caused by methanol, isopropanol, propylene glycol, activated charcoal, mannitol administration, renal failure, and diabetic ketoacidosis, as well as by heavy ethanol consumption with high concentrations of ethanol metabolites (in some cases with little or no ethanol remaining) as may be seen in alcoholic ketoacidosis.
Availability: as needed.
Lipemia: No significant interference from lipemia up to an L index of 500.
Hemolysis: >200 mg/dL will be canceled.
Very high concentrations of lactate (> 30 mEq/L) and lactate dehydrogenase (< 8,000 U/L) have potential to produce falsely elevated ethanol results.
References: (1) Eder AF et al. Ethylene glycol poisoning: toxicokinetic and analytical factors affecting laboratory diagnosis. Clin Chem 44: 168- 177, 1998. (2) Lynd LD et al. An evaluation of the osmole gap as a screening test for toxic alcohol poisoning. BMC Emerg Med 8: 5, 2008. (3) Krasowski MD et al. A retrospective analysis of glycol and toxic alcohol ingestion: utility of anion and osmolal gaps. BMC Clin Pathol 12: 1, 2012. (4) Nine JS, Moraca M, Virji MA, Rao KN. Serum-ethanol determination: comparison of lactate and lactate dehydrogenase interference in three enzymatic assays. J Anal Toxicol 19: 192-196, 1995.
Alcohols Panel (Methanol, Ethanol, Isopropanol, Acetone), Plasma
Glycols (Ethylene and Propylene), Plasma
Ethylene Glycol Rapid Assay, Plasma