Ethanol and the Limitations of the Osmol Gap - 25/01/25
, Anthony Scoccimarro, MD b, d, Kathryn Flickinger, MS, PhD e, Anthony Pizon, MD bAbstract |
Study objective |
The osmol gap can help detect and manage those with toxic alcohol exposure, and it is altered by all alcohols including ethanol. The optimal correction for ethanol that would allow accurate detection of an alternative alcohol is unclear.
Methods |
We conducted a prospective cohort study to assess baseline variations in osmol gap, and then to assess the validity of 2 commonly used coefficients (correction factors) for ethanol. Twenty-two healthy volunteers received a body mass–based dose of oral ethanol that targeted an estimated peak blood ethanol concentration >200 mg/dL. We measured laboratory values prior to ethanol administration and at 2, 4, and 6 hours after ingestion. We considered an osmol gap >10 or <–10 abnormal and an osmol gap of >10 after correction as a false positive.
Results |
Four of the 22 subjects (18%) had an osmol gap >10 at baseline. Following ethanol ingestion and across 66 timepoints (N=66), there were 14 abnormal osmol gap tests (21%) when corrected with an ethanol coefficient of 4.6, and 31 (47%) abnormal tests when corrected using the Purssell ethanol coefficient of 3.7. The mean difference between the baseline and the post-ethanol corrected osmol gap was lower with the molecular weight correction factor of 4.6 compared with the Purssell correction factor of 3.7 (0.2 versus 11.0; P<.001).
Conclusion |
Our data show that the osmol gap is occasionally elevated absent ingestion of any alcohol, and using an ethanol correction coefficient of 4.6 produced a better clinical osmol gap input albeit still with some variation.
Le texte complet de cet article est disponible en PDF.Keywords : Ethanol, Osmol gap, Toxic alcohol exposure
Plan
| Please see page XX for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Andrew A. Monte, MD Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: RM and AP conceived of and designed the project. RM, AP, and KF developed the protocol and obtained approval form the university institutional review board. RM and KF managed the clinical study. RM, ASc, and AP were involved in the carrying out the experiment. AS and RM interpreted the data. AS drafted the manuscript and all authors edited and approved the final manuscript. AS takes responsibility for the manuscript as a whole. |
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| Data sharing statement: All data will be available. Contact Dr. Alexander Sidlak at alexander.sidlak@inova.org. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals' policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have declared that no competing interests exist. |
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