Urine fluorescence in antifreeze poisoning

Description

A 48-year-old man with diabetes mellitus and alcohol abuse presented to the emergency room (ER) with altered mental status, vomiting and abdominal pain. On examination, he was confused and uncooperative with a blood pressure of 70/40 mm Hg, heart rate of 66 beats/min, respiratory rate of 30 breaths/min and oxygen saturation of 95% on room air. Initial venous blood gas showed a 6.57 pH and PaCO₂ of 33 mm Hg. Laboratory investigation showed serum bicarbonate of 5 mEq/L, serum creatinine of 2.5 mg/dL (baseline creatinine 1.1 mg/dL), blood sugar of 200 mg/dL, anion gap of 29 mmol/L, delta ratio of 0.9, lactic acid of 21 mmol/L, a serum osmolality of 360 mOsm/kg and an osmolar gap of 44 mOsm; blood alcohol level was 0.053 g/dL, and urine was negative for ketones. Bedside examination of a urine samples (figure 1) and mouth under Wood's lamp showed blue–green fluorescence, which raised suspicion of ethylene glycol poisoning secondary to antifreeze ingestion. Serum level...

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