04-19-2009, 02:44 PM
A 68-year-old man is brought to the emergency department after an intentional toxic ingestion. He has a history of hypertension and gout. Two years ago, coronary artery bypass graft surgery was performed. He smokes cigarettes but does not use alcohol or illicit drugs.
On physical examination, temperature is 36.7 °C (98 °F), pulse rate is 79/min, respiratory rate is 32/min, and blood pressure is 156/80 mm Hg. He is lethargic and weak, in moderate respiratory distress, and oriented only to place and person. Cardiovascular examination is normal. Pulmonary examination reveals no wheezing.
Laboratory Studies
Glucose 128 mg/dL
Blood urea nitrogen 21 mg/dL
Creatinine 1.2 mg/dL
Sodium 141 meq/L
Potassium 3.9 meq/L
Chloride 103 meq/l
Bicarbonate 11 meq/L
Arterial blood gas studies (with the patient breathing room air):
pH
7.49
PCO2
15 mm Hg
PO2
67 mm Hg
Measurement of which of the following is most likely to establish a diagnosis in this patient?
a.Serum osmolality
b.Ethylene glycol
c.Methanol
d.Salicylate
e.Urinary hippurate
On physical examination, temperature is 36.7 °C (98 °F), pulse rate is 79/min, respiratory rate is 32/min, and blood pressure is 156/80 mm Hg. He is lethargic and weak, in moderate respiratory distress, and oriented only to place and person. Cardiovascular examination is normal. Pulmonary examination reveals no wheezing.
Laboratory Studies
Glucose 128 mg/dL
Blood urea nitrogen 21 mg/dL
Creatinine 1.2 mg/dL
Sodium 141 meq/L
Potassium 3.9 meq/L
Chloride 103 meq/l
Bicarbonate 11 meq/L
Arterial blood gas studies (with the patient breathing room air):
pH
7.49
PCO2
15 mm Hg
PO2
67 mm Hg
Measurement of which of the following is most likely to establish a diagnosis in this patient?
a.Serum osmolality
b.Ethylene glycol
c.Methanol
d.Salicylate
e.Urinary hippurate