Louise MORRELL, MD, RESIDENT IN MEDICINE, JEWISH Hospital at Washington University, St Louis: A 23-year-old man presented to the emergency room of an outside hospital 30 minutes after ingesting 400 to 800 mL of an ethylene glycol–based brake fluid. The patient was agitated and incoherent and had a history of suicide attempts. Laboratory values included the following: plasma sodium, 138 mEq/L (138 mmol/L); potassium, 2.7 mEq/L (2.7 mmol/L); chloride, 103 mEq/L (103 mmol/L); bicarbonate, 14 mEq/L (14 mmol/L); creatinine, 1.0 mg/dL (88.4 μmol/L); arterial oxygen pressure, 105 mm Hg (room air); arterial carbon dioxide pressure, 35 mm Hg; and pH 7.25. The calculated anion gap was 21 mEq/L. The white blood cell count was 16 000/mm3 (16 ×109/L) with a hemoglobin level of 15 g/dL (150 g/L) and a hematocrit of 35% (0.35).
The patient underwent gastric lavage with normal saline and received intravenous sodium bicarbonate (50