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| * Medicine question 26 |
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Sam is a 35 y/o alcoholic who is brought to the ER in a comatose state. Sam’s wife tells you that she had an argument in the evening about 5 hrs ago over Sam’s alcohol habits. Sam apparently got mad over the discussion, drove his car and returned an hour ago in a very intoxicated state. Wife called the EMS and rushed him to the ER. On examination Sam is disoriented and hallucinating , Pulse 120 Tm 99, RR 26 BP 126/76. The rest of the physical exam is normal except for stuporos state and alcohol smell. Lab studies revealed Na 130 k 3.4 cl- 95 Hco3 16, Glucose 90 Creatinine 1.6 BUN 45. Blood Ethylalcohol level was 180. Serum osmolarity was 360mg%. ABGs revealed 7.28, Pco2 28, Po2 76 Sao2 93. The next best step in management ?
A) Endotracheal intubation in view of severe acidosis
B) Hemodialysis because this is an acute renal failure causing acidosis
C) Fomepizole because of suspicion of ethylene glycol intoxication
D) Supportive treatment for now because this is an ethylalcohol induced lactic acidosis
E) Bicarbonate drip to reverse the acidosis because this is renal tubular acidosis
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| * Re:Medicine question 26 |
| #2315620 |
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Answer C
fomepizole is the inhibitor of alcohol dehydrogenase and is the antidote for suspected ethylene glycol poisoning. Ethylene glycol poisoning in this case can be diagnosed by the prolonged Osmolar gap which can not be explained by high ethyl alcohol level alone. ( from Dr.red lectures on acid-base) |
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