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Comment & Response |

Toxic Alcohol Calculations and Misinterpretation Of Laboratory Results—Reply

Michael Fralick, MD1; Kenneth Lam, MD1; Megan E. Himmel, PhD2
[+] 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.
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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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April 1, 2016
Megan E. Himmel, PhD; Kenneth Lam, MD; Michael Fralick, MD
1University of Toronto Medical School, Toronto, Ontario, Canada
2Internal Medicine Program, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
JAMA Intern Med. 2016;176(4):431-432. doi:10.1001/jamainternmed.2015.8447.
August 1, 2016
Peter E. Wu, MD, MSc, FRCPC; Marco L. A. Sivilotti, MD, MSc, FRCPC, FACEP, FACMT
1Ontario Poison Centre, Toronto, Ontario, Canada2Division of Clinical Pharmacology & Toxicology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
3Department of Emergency Medicine, Queen’s University, Kingston, Canada4Department of Biomedical & Molecular Science, Queen’s University, Kingston, Canada
JAMA Intern Med. 2016;176(8):1227-1228. doi:10.1001/jamainternmed.2016.3714.
August 1, 2016
Mark K. Su, MD, MPH; Robert S. Hoffman, MD
1Division of Medical Toxicology, The Ronald O. Perelman Department of Emergency Medicine, New York, New York
JAMA Intern Med. 2016;176(8):1228. doi:10.1001/jamainternmed.2016.3717.
August 1, 2016
Giuseppe Lippi, MD; Mario Plebani, MD
1Section of Clinical Biochemistry, University of Verona, Verona, Italy
2Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
JAMA Intern Med. 2016;176(8):1228-1229. doi:10.1001/jamainternmed.2016.3720.
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