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Test ID: VOLEG    
Volatile and Ethylene Glycol Profile

Useful For Suggests clinical disorders or settings where the test may be helpful

Detection and quantitation of acetone, methanol, isopropanol, and ethanol in serum

 

Confirming and monitoring ethylene glycol toxicity

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Volatiles:

Volatile substances in the blood include acetone, methanol, isopropanol, and ethanol. Acetone is generally elevated in metabolic conditions such diabetic ketoacidosis. Methanol and isopropanol are highly toxic and result from exogenous ingestion.

 

Ethanol is the single most important substance of abuse in the United States. It is the active agent in beer, wine, vodka, whiskey, rum, and other liquors. Ethanol acts on cerebral function as a depressant similar to general anesthetics. This depression causes most of the typical symptoms of intoxication including impaired thought, clouded judgment, and changed behavior. As the level of alcohol increases, the degree of impairment becomes progressively increased.

 

Ethylene Glycol:

Ethylene glycol is the active ingredient in automobile antifreeze which is sometimes consumed as a substitute for ethanol since in the early stages the inebriating effects of the 2 chemicals are similar. It is converted to several toxic, acidic metabolites including oxalic acid, which precipitates as calcium oxalate crystals in the kidney, identifiable as such in the urine.

 

Toxic manifestations include central nervous system depression, nausea and vomiting, muscle paralysis, ataxia, renal failure, congestive heart failure, pulmonary edema, convulsions, and coma. Other findings included pronounced metabolic acidosis with large anion gap and Kussmaul respirations, osmolar gap, and hypocalcemia.

 

4-Methylpyrazole is the antidote of choice; however, ethanol administered in 10% concentration of D5W may also be used as an antidote. Both antidotes inhibit conversion of the relatively nontoxic ethylene glycol to its toxic metabolites.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

ETHYLENE GLYCOL

Toxic concentration: > or =20 mg/dL

 

ETHANOL

None detected (cutoff concentration: 10 mg/dL)

Toxic concentration: > or =400 mg/dL

 

METHANOL

None detected (cutoff concentration: 10 mg/dL)

Toxic concentration: > or =10 mg/dL

Positive results are quantitated.

 

ACETONE

None detected (cutoff concentration: 10 mg/dL)

Toxic concentration: > or =10 mg/dL

 

ISOPROPANOL

None detected (cutoff concentration: 10 mg/dL)

Toxic concentration: > or =10 mg/dL

Interpretation Provides information to assist in interpretation of the test results

Volatiles:

Toxic concentrations:

Methanol: > or =10 mg/dL

Isopropanol: > or =10 mg/dL

Acetone: > or =10 mg/dL

Ethanol: > or =400 mg/dL

 

Ethylene Glycol:

Toxic concentration: > or =20 mg/dL

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Propionic acid produced in the rare inborn error of metabolism, methylmalonic acidemia, may be confused with ethylene glycol in the gas chromatographic assay.

Clinical Reference Provides recommendations for further in-depth reading of a clinical nature

1. Levine B: Principles of Forensic Toxicology. AACC Press, 1999

2. Tietz NW: Clinical Guide to Laboratory Tests. 2nd edition. Philadelphia, WB Saunders Company, 1990, pp 208-209