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Comment & Response
August 2016

Toxic Alcohol Calculations and Misinterpretation Of Laboratory Results—Reply

Author Affiliations
  • 1Internal Medicine Program, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 2Undergraduate Medical Program, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
JAMA Intern Med. 2016;176(8):1229-1230. doi:10.1001/jamainternmed.2016.3729

In Reply We appreciate the interest and comments provided by Su and Hoffman, Lippi and Plebani, and Wu and Sivilotti in regards to our Teachable Moment “Hemodialysis in a Healthy Patient—A Case of an Erroneous Laboratory Result.”1

Su and Hoffman are correct that a low or normal osmolar gap does not exclude methanol poisoning. Specifically, in the later stages of methanol poisoning the osmolar gap may be normal, and the anion gap may be elevated.2 We further agree that being aware of the most up-to-date recommendations3 for the management of methanol toxic effects can be challenging, and that when in doubt it is prudent to consult a medical toxicologist. In our case, the poison control center was consulted, and they made recommendations that were based on the available guidelines at that time.4

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