List 3 drugs or poisons that, when taken as an overdose, result in both a raised osmolar gap and anion gap. List the major anion associated with each drug responsible for the rise in anion gap.
Ethanol - Lactate
Methanol - Formate or formic acid
Ethylene glycol - Glycolate / oxalate
Ethanol overindulgeance can indeed cause a lactic acidosis, but I would have chosen a different drug:
- Toxicological causes of high anion and high osmolar gap
- Methanol intoxication (the anion is formic acid)
- Ethylene glycol intoxication (the anions are glycolic acid and oxalic acid)
- Diethylene glycol intoxication (the anion is 2-hydroxyethoxyacetic acid, HEAA)
- Propylene glycol intoxication (the anions are pyruvate, lactate and acetate)
- Salicylate intoxication (the anions are salicylate and lactate)
- Any toxin causing massive lactic acidosis, eg. isoniazid
- Endocrine and metabolic causes of high anion and high osmolar gap
- Lactic acidosis
- Alcoholic or diabetic ketoacidosis
- Acute kidney injury
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