No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
A 2-year-old presents following methanol ingestion with serum creatinine of 8.6 mg/dl: Questions
ResearchGate has not been able to resolve any citations for this publication.
We assessed a 2-year 4-month-old boy found to have a persistently elevated serum creatinine (peak 926 μmol/L) as measured by the Jaffe reaction after ingesting an unknown quantity of fuel for a model car, which commonly contains nitromethane. The patient was otherwise clinically well and the remaining investigations were unremarkable. When creatinine concentrations were measured with specific enzymatic testing on these same blood samples, all values were within normal limits. Nitromethane has been shown to interfere with the determination of serum creatinine through the Jaffe reaction. Because many ingestions present only rarely, it is not possible for the emergency department clinician to be aware of all toxin factors affecting patient management. This case illustrates the importance of analysis of laboratory results in the context of the patient's clinical status.
A 2 years 9 month-old-boy who ingested model aviation fuel was found to have an elevated serum creatinine concentration of 0.53 mmol/L (normal range 0.02-0.05 mmol/L) by the Jaffe (alkaline picrate) reaction. However, when the creatinine concentration was measured using a specific enzymatic assay, it was within the normal range. It was shown that nitromethane, a constituent of aviation fuel, interferes with the Jaffe reaction, leading to a falsely elevated creatinine reading. This phenomenon has been reported only once previously and, despite its potential clinical importance, nitromethane does not appear in published lists of substances that interfere with the Jaffe reaction.
To report a case of co-ingestion of methanol and nitromethane in a child in order to heighten the awareness of false elevation of serum creatinine from nitromethane ingestion.
Case report.
Pediatric intensive care unit.
A 4-yr-old previously healthy girl ingested an unknown quantity of "Blue Thunder" model-engine fuel, which consisted of methanol and nitromethane. The patient was treated with fomepizole for methanol ingestion using elevated creatinine level as a reason for treatment.
The patient was asymptomatic but her creatinine level increased ten-fold (from 0.4 mg/dL to 4 mg/dL) within 6 hrs. Blood urea nitrogen, anion gap, and osmolar gap remained within normal limits. When the serum creatinine level was measured with enzymatic method instead of Jaffe's method, a normal creatinine level was obtained. The falsely elevated creatinine level was due to nitromethane.
The falsely elevated serum creatinine levels due to nitromethane ingestion can lead to unnecessary therapeutic interventions. We intend to heighten awareness of this potential misstep by reporting this case.
Alcohol-related intoxications, including methanol, ethylene glycol, diethylene glycol, and propylene glycol, and alcoholic ketoacidosis can present with a high anion gap metabolic acidosis and increased serum osmolal gap, whereas isopropanol intoxication presents with hyperosmolality alone. The effects of these substances, except for isopropanol and possibly alcoholic ketoacidosis, are due to their metabolites, which can cause metabolic acidosis and cellular dysfunction. Accumulation of the alcohols in the blood can cause an increment in the osmolality, and accumulation of their metabolites can cause an increase in the anion gap and a decrease in serum bicarbonate concentration. The presence of both laboratory abnormalities concurrently is an important diagnostic clue, although either can be absent, depending on the time after exposure when blood is sampled. In addition to metabolic acidosis, acute renal failure and neurologic disease can occur in some of the intoxications. Dialysis to remove the unmetabolized alcohol and possibly the organic acid anion can be helpful in treatment of several of the alcohol-related intoxications. Administration of fomepizole or ethanol to inhibit alcohol dehydrogenase, a critical enzyme in metabolism of the alcohols, is beneficial in treatment of ethylene glycol and methanol intoxication and possibly diethylene glycol and propylene glycol intoxication. Given the potentially high morbidity and mortality of these intoxications, it is important for the clinician to have a high degree of suspicion for these disorders in cases of high anion gap metabolic acidosis, acute renal failure, or unexplained neurologic disease so that treatment can be initiated early.
A. Chua Department of Pediatrics, Levine Children's Hospital at Carolinas Medical Center, Charlotte, NC 28232,*) Division of Nephrology and Hypertension, Levine Children's Hospital, 1001 Blythe Boulevard
- D J Weaver Jr
- D J Usa
- Weaver
- Jr
D. J. Weaver Jr. : A. Chua Department of Pediatrics, Levine Children's Hospital at Carolinas Medical Center, Charlotte, NC 28232, USA D. J. Weaver Jr. (*) Division of Nephrology and Hypertension, Levine Children's Hospital, 1001 Blythe Boulevard, Ste 200, Charlotte, NC 28232, USA e-mail: Jack.Weaver@carolinashealthcare.org Pediatr Nephrol DOI 10.1007/s00467-014-2920-6
A. Chua Department of Pediatrics, Levine Children's Hospital at Carolinas Medical Center*) Division of Nephrology and Hypertension, Levine Children's Hospital
- D J Weaver Jr
- J Usa D
- Weaver Jr
D. J. Weaver Jr. : A. Chua
Department of Pediatrics, Levine Children's Hospital at Carolinas
Medical Center, Charlotte, NC 28232, USA
D. J. Weaver Jr. (*)
Division of Nephrology and Hypertension, Levine Children's
Hospital, 1001 Blythe Boulevard, Ste 200, Charlotte, NC 28232,
USA
e-mail: Jack.Weaver@carolinashealthcare.org
Pediatr Nephrol (2015) 30:1803
DOI 10.1007/s00467-014-2920-6
What is the most likely explanation for elevation in the patient's serum creatinine? 2. What was the clue that raised suspicion for the diagnosis? The answer to this question can be
What is the most likely explanation for elevation in the patient's serum
creatinine?
2. What was the clue that raised suspicion for the diagnosis?
The answer to this question can be found at http://dx.doi.org/10.1007/
s00467-014-2934-0.