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Old 10-10-2012
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Arrow Gyrus Daily Questions; Toxicology #1

A patient with metabolic acidosis, reduced anion gap, and increased osmolal gap is most likely to have which of the following toxic ingestions?
A. Lithium
B. Methanol
C. Oxycodone
D. Propylene glycol
E. Salicylate
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B
Methanol, ethylene glycol and ethanol give reduced anion gap with increased osmolar gap
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Quote:
Originally Posted by XpaezX View Post
B
Methanol, ethylene glycol and ethanol give reduced anion gap with increased osmolar gap
I am confused coz i think Methanol, ethylene glycol and ethanol give increase anion gap and also Salicylate.So z answer may be A. Lithium or C. Oxycodone
Finally guess ans A. Lithium

Last edited by heartbeat; 10-11-2012 at 12:13 AM.
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Originally Posted by heartbeat View Post
I am confused coz i think Methanol, ethylene glycol and ethanol give increase anion gap and also Salicylate.So z answer may be A. Lithium or C. Oxycodone
Finally guess ans A. Lithium
H my god you are right mybad hahahaha
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After seeing how stupid my first response was answer is A Lithium, as it behaves like sodium you add more cations to the formula and thus the anion gap is reduced
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The answer is A. Lithium

Lithium interferes with cell membrane ion transport, leading to nephrogenic diabetes insipidus and falsely elevated chloride. This can cause the appearance of low anion gap metabolic acidosis. Sequelae include nausea, vomiting, ataxia, encephalopathy, coma, seizures, arrhythmia, hyperthermia, permanent movement disorder, and/or encephalopathy.

Severe cases are treated with bowel irrigation, endoscopic removal of long-acting formulations, hydration, and sometimes hemodialysis. Care should be taken because toxicity occurs at lower levels in chronic toxicity compared
to acute toxicity. Salicylate toxicity leads to a normal osmolal gap as well as an elevated anion gap metabolic acidosis, respiratory alkalosis, and sometimes normal anion gap metabolic acidosis. Methanol toxicity is associated with blindness and is characterized by an increased anion gap metabolic acidosis, with normal lactate and ketones, and a high osmolal gap. Propylene glycol toxicity causes an increased anion gap metabolic acidosis with elevated lactate and a high osmolal gap. The only electrolyte abnormalities associated
with opiate overdose are compensatory to a primary respiratory acidosis
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