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If you see a case of a patient who's usually an alcoholic or a drug addict and who presented with obtundation and acute renal failure and a urine that shows envelop shaped crystals and a metabolic panel showing an elevated anion gap acidosis then immediately think of Oxalicaciduria causing acute renal failure.

The oxalate crystals came from an ingestion of ethylene glycol (anitfreeze) and the treatment is best with Fomepizole.
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