2,3-Butanediol: An Unusual Metabolite in the Serum of Severely Alcoholic Men During Acute Intoxication

Rutstein, David D.; Nickerson, RitaJ.; Vernon, AndrewA.; Kishore, Punyamurtula; Veech, R L; Felver, MichaelE.; Ll, Needham; Thacker, StephenB.

doi:10.1016/s0140-6736(83)90568-8

Cited by 67 publications

(18 citation statements)

References 4 publications

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“…In alcoholics, during their alcohol consumption period, isopropanol, acetate, acetone, and methanol increases in the plasma, raising the potential that these compounds could perhaps be used as markers of the alcoholic state [159]. Beside acetone, ethanol, and the aforementioned compounds, the role of abnormal metabolites (acetoin, 2,3-butanediol, 1,2-propanediol) was also strongly highlighted [160][161][162][163]. The formation of these compounds is a result of disturbed NADH+H + formation that directs reactions toward the production of minor metabolites.…”

Section: Breath Acetone Measurementsmentioning

confidence: 99%

Breath acetone as a potential marker in clinical practice

Ruzsányi

Kalapos²

2017

J. Breath Res.

133

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In recent decades, two facts have changed the opinion of researchers about the function of acetone in humans. Firstly, it has turned out that acetone cannot be regarded as simply a waste product of metabolism, because there are several pathways in which acetone is produced or broken down. Secondly, methods have emerged making possible its detection in exhaled breath, thereby offering an attractive alternative to investigation of blood and urine samples. From a clinical point of view the measurement of breath acetone levels is important, but there are limitations to its wide application. These limitations can be divided into two classes, technical and biological limits. The technical limits include the storage of samples, detection threshold, standardization of clinical settings, and the price of instruments. When considering the biological ranges of acetone, personal factors such as race, age, gender, weight, food consumption, medication, illicit drugs, and even profession/class have to be taken into account to use concentration information for disorders. In some diseases such as diabetes mellitus and lung cancer, as well as in nutrition-related behavior such as starvation and ketogenic diet, breath acetone has been extensively examined. At the same time, there is a lack of investigations in other cases in which ketosis is also evident, such as in alcoholism or an inborn error of metabolism. In summary, the detection of acetone in exhaled breath is a useful and promising tool for diagnosis and it can be used as a marker to follow the effectiveness of treatments in some disorders. However, further endeavors are needed for clarification of the exact distribution of acetone in different body compartments and evaluation of its complex role in humans, especially in those cases in which a ketotic state also occurs. RECEIVED

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Section: Breath Acetone Measurementsmentioning

confidence: 99%

Breath acetone as a potential marker in clinical practice

Ruzsányi

Kalapos²

2017

J. Breath Res.

133

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“…These include abnormal forms of blood transferrin (217), linoleic acid of serum lecithin (218), platelet monoamine oxidase (219), superoxide dismutase (220) and 2,3-butanediol (221,222).…”

Section: Inhibition Of Hepatic Regenerationmentioning

confidence: 99%

Alcohol and the Liver: 1984 Update

Lieber

1984

Hepatology

145

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“…An alternative method that uses a modified veterinary enzymatic assay has been developed and validated (1 ). This veterinary enzymatic assay had been rejected for use with human samples because of concern over interference by propylene glycol and various butanediols, some of which may be increased in chronic alcohol users (10 ). The development in 2011 of a modified assay that uses kinetic rate analysis has improved the assay's analytic specificity and has eliminated most false-positive results.…”

Section: Discussionmentioning

confidence: 99%

Osmolal Gap without Anion Gap in a 43-Year-Old Man

2014

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A 43-year-old man presented to the emergency department (ED) 3 2 h after ingesting 10 oz of antifreeze mixed with Gatorade in a suicide attempt. The antifreeze was green, of an unknown brand, and purchased at a local gas station. He subsequently confessed to his wife, who brought him to a community hospital ED. He denied abdominal pain, nausea, vomiting, urinary symptoms, or visual changes. Initial laboratory tests (Table 1) With the advice of the local Poison Control Center, the patient was given 15 mg/kg fomepizole intravenously. He was placed on suicide precautions and transferred to a tertiary care center for further evaluation and treatment. On arrival at the tertiary care ED 8 h after ingestion and 3 h after fomepizole administration, the patient had a normal mental status and normal vital signs. Thiamine (100 mg), folic acid (50 mg), and pyridoxine (50 mg) were administered intravenously as cofactors for secondary metabolic pathways. At that time, laboratory test results (Table 1) were clinically relevant for the following: arterial whole-blood pH, 7.39; PCO 2 , 28 mmHg (3.7 kPa); serum bicarbonate, 18 mmol/L; creatinine, 1.1 mg/dL (97.2 mol/L); lactate, 5.3 mmol/L; anion gap, 14 mmol/L; and osmolal gap, 72 mOsm/kg. No crystals were visible in the urine. CASE FOLLOW-UPGiven the improving anion gap and the lack of clinically relevant acidemia, there was debate about whether this patient had actually ingested ethylene glycol (EG) or had instead ingested propylene glycol (found in "safer" antifreezes) or isopropyl alcohol. Therefore, a test for the serum concentration of EG was ordered for confirmation. The sample for measurement of EG by gas chromatography had to be sent by courier to the closest clinical laboratory offering the test, with the results expected in 4 -8 h. While the sample was en route for testing by gas chromatography, the hospital pathologist performed a modified version of a commercially available veterinary enzymatic assay. This test had been validated by our laboratory, and the results of these studies have been published (1 ). The serum concentration of EG (Table 1) measured by enzymatic assay was 308 mg/dL (49.6 mmol/L). On the basis of this information, the patient was continued on fomepizole, and plans were made for hemodialysis. Ten hours after admission, the gas chromatography result indicated an EG concentration of 315 mg/dL (50.9 mmol/L), in close agreement with the results of the enzymatic assay (the gas chromatography results were negative for methanol and isopropyl alcohol). After hemodialysis was performed, the patient's postdialysis serum showed an osmolal gap of 6 mOsm/kg and an EG concentration of 50 mg/dL (8.2 mmol/L). After a second hemodialysis course, the EG concentration according to the enzymatic assay was 1.4 mg/dL (0.2 mmol/L); the fomepizole treatment was then discontinued. The patient's renal function remained normal, and he recovered completely. He was discharged from the hospital to a psychiatric treatment facility.

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2,3-Butanediol: An Unusual Metabolite in the Serum of Severely Alcoholic Men During Acute Intoxication

Cited by 67 publications

References 4 publications

Breath acetone as a potential marker in clinical practice

Breath acetone as a potential marker in clinical practice

Alcohol and the Liver: 1984 Update

Osmolal Gap without Anion Gap in a 43-Year-Old Man

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