Creatinine = 93.6 mg/dL; Osmolar Gap = 148 . . . Diagnosis?

April 11, 2010, 12:14 pm

★★★½☆

Blue Thunder Ingestion: Methanol, Nitromethane, and Elevated Creatinine. Ngo AN et al.  J Med Toxicol [published online 30 March 2010]

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This fascinating case report is from the California Poison Control System.  A 41-year-old male presented to the emergency department in a state of intoxication, saying he had ingested vodka and “Blue Thunder” model racing car fuel.  His ethanol level was non-detectable.  Pertinent laboratory results included glucose 117 mg/dL, BUN 7.9 mmol/L, creatinine 93.6 mg/dL [normal 0.5 – 1.2 mg/dL), anion gap 17, and osmolar gap 148.  Sample for methanol level was sent to an outside laboratory.

The authors point out that model remote-control car fuels contain methanol, nitromethane, and lubricants such as castor oil. (The patient was covered with feces on presentation.) They note that nitromethane causes false elevation of creatinine level measured by the Jaffe colorimetric method. (The presence of nitromethane does not affect creatinine levels measured by enzymatic methods.)  Using the spuriously elevated creatinine level of 93.6 mg/dL and the osmolar gap, the authors were able to calculate that the serum methanol level was approximately 400 mg/dL (details in paper).  Treatment included fomepizole and hemodialysis.  Two days after admission the outside laboratory reported an initial serum methanol level of 399 mg/dL.

One Comment:

  1. Neuroskeptic Says:

    Maybe this happened because they sell Blue Thunder in packaging that makes it look like an energy drink…