Question

A person comes to the emergency department after consumption of a substance, the form and dose of which is not known to relatives. The patient shows tachypnea, hypotension. On metabolic assessment, high anion gap acidosis is noted with hypocalcemia. Diagnosis?

• A. Methyl alcohol
• B. Ethylene glycol
• C. Dhatura
• D. Ethyl alcohol

Hint:

Ethylene glycol poisoning can be life-threatening, with metabolic acidosis and hypocalcemia being key diagnostic signs.

Answer 1

The Correct Option is B

The case presented indicates a patient with symptoms of tachypnea, hypotension, and high anion gap metabolic acidosis with hypocalcemia. These clinical findings lead us to consider toxicology as a cause, specifically substances that can cause metabolic acidosis with a high anion gap.

To identify the likely substance causing these symptoms, we consider common agents:

1. Methyl alcohol (methanol): Can cause metabolic acidosis with a high anion gap, but does not typically cause hypocalcemia.
2. Ethylene glycol: Causes high anion gap metabolic acidosis. One of its metabolites, oxalic acid, reacts with calcium to form calcium oxalate crystals, leading to hypocalcemia.
3. Dhatura: Generally causes anticholinergic toxicity rather than metabolic acidosis with these symptoms.
4. Ethyl alcohol (ethanol): Can cause acidosis, but it usually causes increased serum osmolality and not hypocalcemia.

Given the presence of both high anion gap acidosis and hypocalcemia, ethylene glycol ingestion is the most likely diagnosis.