UTILIZING THE OSMOLAR GAP TO DETERMINE WHEN TO DISCONTINUE DIALYSIS IN ACUTE ALCOHOL INTOXICATION

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UTILIZING THE OSMOLAR GAP TO DETERMINE WHEN TO DISCONTINUE DIALYSIS IN ACUTE ALCOHOL INTOXICATION

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Co-author 1

Ziad Elhusseini zeyad_abdelgawad@hotmail.com Adan Hospital Medicine Department Ahmadi Kuwait -

Co-author 2

Reem Asad raasad@gmail.com Adan Hospital Medicine Department Ahmadi Kuwait *

Co-author 3

Wael Draz drdraz74@gmail.com Adan Hospital Medicine Department Ahmadi Kuwait -

Co-author 4

Hesham Zamel Dr_heshamzamel@yahoo.com Adan Hospital Medicine Department Ahmadi Kuwait -

Co-author 5

Bassam Alhelal dr.alhelal@gmail.com Adan Hospital Medicine Department Ahmadi Kuwait -

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Introduction

Acute alcohol intoxication is a medical emergency that requires prompt toxin removal for recovery. In Kuwait, where alcohol production and consumption are illegal, the use of homemade alcohol increases the risk of poisoning. Methanol and ethylene glycol are particularly dangerous, as they raise both the anion and osmolal gaps, aiding diagnosis. However, many hospitals lack 24-hour methanol testing, which can delay treatment.Methanol concentrations above 500 mg/L are generally considered an indication for extracorporeal treatment (ECTR) in acute poisoning. Since methanol assays are not routinely available, the osmolar gap (OG) serves as a surrogate marker, correlating well with serum methanol levels and being more readily measured.This study aimed to evaluate the usefulness of the osmolar gap in guiding the discontinuation of hemodialysis in patients with acute methanol poisoning.

Methods

A prospective observational study was conducted at Adan Hospital's intensive care unit from January 2021 to January 2024. Patients with acute alcohol intoxication were included, with diagnosis based on clinical history, signs of toxic alcohol ingestion, and metabolic acidosis with elevated anion or osmolal gaps. Continuous venovenous hemodiafiltration (CVVHDF) was performed in patients with high anion gap acidosis or persistent acidosis despite initial treatment. Dialysis was continued until the osmolar gap decreased to below 15 mOsm/kgH2O, with improved metabolic acidosis

Results

Seventy-three patients received dialysis. The mean osmolar gap before dialysis was 52 ± 28.23, decreasing to 5.83 ± 4.6 before stopping dialysis, with normal pH maintained 48 hours after dialysis. None of the patine required re-initiating dialysis.

Conclusion

The osmolar gap is an effective guide for safely terminating dialysis in acute methanol poisoning, with dialysis recommended until the osmolar gap falls below 15 mOsm/kgH2O

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