Rosh Review EM Scholar Monthly Question

A 45-year-old man is brought in by EMS after being found unconscious by his partner. He is confused and agitated. His vital signs are a BP of 90/60 mm Hg, HR of 120 bpm, RR of 24/min, and T of 37.6°C. His laboratory findings include the following:

• Sodium: 125 mEq/L
• Chloride: 90 mEq/L 
• Potassium: 3.2 mEq/L
• Bicarbonate: 24 mEq/L
• Blood urea nitrogen: 28 mg/dL
• Creatinine: 1.0 mg/dL
• Ethanol: 322 mg/dL
• Glucose: 72 mg/dL
• Osmolality: 350 mOsm/kg
• Venous blood gas: pH 7.36, PCO2 45 mm Hg, PO2 95 mm Hg
• Urinalysis: 4+ ketones

Which of the following is most consistent with this patient’s presentation?

1. Ethanol and isopropyl alcohol intoxication
2. Ethanol intoxication only
3. Ethylene glycol and ethanol intoxication
4. Methanol and ethanol intoxication
   

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References

1. Kraut JA, Mullins ME. Toxic alcohols. N Engl J Med. 2018;378(3):270–280. https://www.nejm.org/doi/10.1056/NEJMra1615295
2. Lima R. Toxic alcohols. NUEM blog website. Accessed March 27, 2023. https://www.nuemblog.com/blog/toxic-alcohols

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)