Initial Check

Course: WB 4342
CE Original Date: March 20, 2020
CE Renewal Date: March 20, 2022
CE Expiration Date: March 20, 2024
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This Initial Check will help you assess your current knowledge about ethylene glycol toxicity. To take the Initial Check, read the case below and then answer the questions that follow.

Case Study, First Patient
Disorientation, Ataxia, and Abdominal Symptoms in Visitors to a Municipal Airport

A 67-year-old man arrives at the emergency department (ED) of a small community hospital where you are the family physician on call. The patient is experiencing

  • ataxia,
  • dizziness, and
  • vomiting.

He is hyperventilating. On physical examination, the patient appears well nourished, but agitated and disoriented. He has no odor of ethanol on his breath.

Vital Signs

The patient’s vital signs are as follows:

  • Blood pressure (BP): 120/80 mm Hg
  • Temperature: 98.5°F
  • Pulse: 80 beats/minute
  • Respirations: 40 breaths/minute

Neurologic examination is otherwise normal, with no focal findings, particularly no nystagmus. Abdominal examination is normal.

Additional Information

The patient’s friend brought him to the ED. The friend said that late the previous night the patient complained of dizziness and had begun to vomit. The patient was hyperventilating in the morning and continued to vomit. Both men are retired pilots who teach at the local airport’s ground school. The friend wonders whether the food at the airport cafeteria was responsible because two other people collapsed at the airport that morning and were taken by ambulance to another hospital. Both the friend and the patient ate hot dogs and coleslaw from the cafeteria, but the friend states that he feels fine.

Results of Laboratory Tests
  • Blood ethanol and routine urine drug screen are negative.
  • Arterial blood gases (ABG) results: pH 7.10; PaCO₂ = 20 mm Hg; PaO₂ = 95 mm Hg; and bicarbonate = 8 mEq/L.
  • Sodium: 145 mmol/L (normal 135–145 mmol/L).
  • Potassium: 3.8 mmol/L (normal 3.1–5.3 mmol/L).
  • Chloride: 105 mEq/L (normal 98–109 mEq/L).
  • BUN: 20 mg/dL (normal 8–18 mg/dL).
  • Creatinine: 1.0 mg/dl (normal 0.6–1.2 mg/dL).
  • Glucose: 80 mg/dl (normal 65–110 mg/dL).
  • Calculated anion gap: 32 (normal 12–16).

Note that results might vary from laboratory to laboratory and depend on the elevation above sea level (see Table 1).

Table 1. Arterial blood gases – Ranges Considered Within Normal Limits at Sea Level and Breathing Room Air.
Partial pressure of oxygen (PaO2) 70–100 millimeters of mercury (mm Hg)
Partial pressure of carbon dioxide (PaCO2) 35–45 mm Hg
pH 7.35–7.44
Bicarbonate (HCO3) 21–28 milliequivalents per liter (mEq/L)
Oxygen content (O2CT) 15%–23% (15–23 milliliters [mL] per 100 mL of blood)
Oxygen saturation (O2Sat) 95%–100%
Case Study, Second Patient

Fewer than 30 minutes later, a 4-year-old boy arrives at the ED. On examination, you find a sleepy but responsive child who shows no evidence of trauma or focal neurologic signs. Abdominal examinations are normal.

Vital Signs

The patient’s vital signs are as follows:

  • BP: 94/76 mm Hg
  • Rectal temperature: 98.5°F
  • Respirations: 12 breaths/minute
  • Pulse: 78 beats/minute
Additional Information

The parents tell you they were attending a local fliers’ club luncheon at the airport. When they noticed the child staggering and incoherent, they rushed him to the ED. On the way, he vomited in the car.

Results of Laboratory Tests

You order the same laboratory tests for the child that you ordered for the 67-year-old patient. The tests reveal that the child is

  • hypoglycemic,
  • has slight acidosis, and
  • has an anion gap of 13.
Additional Information

You contact the local health department. They tell you they are investigating the earlier incidents at the airport. They have not identified the contaminant, but they suspect the airport’s water supply is contaminated.

Initial Check Questions