Spurious Elevation in Serum Creatinine Caused by Ingestion of Nitromethane: Implication for the Diagnosis and Treatment of Methanol Intoxication

Rastogi, Anjay; Itagaki, B. K.; Bajwa, Meera; Kraut, Jeffrey A.

doi:10.1053/j.ajkd.2007.12.010

Cited by 11 publications

(7 citation statements)

References 22 publications

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“…This case illustrates the interaction of nitromethane with the Jaffe method, which has been previously observed clinically 5,6 and demonstrated in vitro. 7,8 However, to our knowledge this is the first case reported in the UK.…”

Section: Discussionsupporting

confidence: 54%

Can a spuriously raised creatinine by Jaffe method be helpful in poisoning?

Lakin¹,

Booth²,

McCann

et al. 2011

Pediatrics International

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We report the case of a 2-year-old girl who accidentally ingested model car fuel (nitromethane). As there was a possibility that this was in fact ethylene glycol, blood investigations were performed. These were normal except for a creatinine of 274 mmol/L. Nitromethane interferes with the Jaffe method of creatinine estimation, which was confirmed by two alternative methods of analysis. Our patient's creatinine normalized after 36 h. This case highlights the importance of being aware of a raised creatinine in this situation and accurately identifying any poison in question. Case reportA previously well, 2-year-old girl presented to Accident and Emergency having ingested an unknown quantity of a blue liquid presumed to be model vehicle fuel. Although there was debate about whether this was ethylene glycol, her parents confirmed it was nitromethane. Vital signs and physical examination were unremarkable. As she was asymptomatic she was admitted for observation. Due to the possibility that the liquid was ethylene glycol, which would have required definitive treatment, blood investigations, including renal function and osmolar gap, were sent.Blood investigations revealed a creatinine of 274 mmol/L (normal 35-62) and the remainder of the blood investigations were normal (Table 1). Given that there was no history suggestive of renal disease and that the biochemistry was otherwise normal, a second blood sample was obtained. This was taken at approximately 12 h once the initial sample was rechecked and advice was obtained from the UK National Poisons Centre. This confirmed an isolated raised creatinine of 234 micromol/L.It was suspected that this was due to the previously reported phenomenon of the interference with the standard "Jaffe" method of creatinine estimation. To confirm this, the blood samples were sent for comparative analysis, at an external laboratory, using two alternative creatinine-specific methods 3,4 : mass spectrometry and enzymatic measurement. The results are summarized in Table 2 and confirm interference with the standard method.During her admission our patient remained clinically well. Although not formally measured, there were no clinical concerns regarding her urine output. Her urine was not biochemically assessed. She was discharged the following day with a plan to return 48 h after ingestion to have her renal function rechecked. When our patient returned her creatinine was normalizing and had normalized a week later. DiscussionThis case highlights that poisoning remains a common clinical problem and it is a significant cause of morbidity in children. Between 1993 and 1999 there were an estimated 15 106 attendances to Accident and Emergency for poisoning in children due to ingestion of solvents or fuels in the UK. 1 Nitromethane is an organic compound that is commonly used as a solvent and as a fuel for high-performance vehicles. Its acute toxic potential is low, although it may cause skin and eye irritation, respiratory and gastrointestinal disturbance and central nervous system (CNS) depression...

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Section: Discussionsupporting

confidence: 54%

Can a spuriously raised creatinine by Jaffe method be helpful in poisoning?

Lakin¹,

Booth²,

McCann

et al. 2011

Pediatrics International

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show abstract

“…As a consequence, this test cannot be done in many clinical laboratories and blood has to be sent to a specialty laboratory. As reported by one of the authors, it can take 48 hours or longer to get the results (8). A long delay before recognition is important because treatment of the intoxications to be effective should be initiated within several hours or less after ingestion to prevent serious adverse consequences (2,4,5,13).…”

Section: Discussionmentioning

confidence: 96%

“…Because of their cost, they are often not available in many hospital clinical laboratories (6,7). As a consequence, even when the diagnosis of one of the toxic alcohol ingestion is suspected, confirmation of the diagnosis can take as long as 48 hours, placing the patient at risk for many of the complications including death (2,8). …”

Section: Introductionmentioning

confidence: 99%

Simple diagnostic tests to detect toxic alcohol intoxications

Shin

Sachs

Kraut

2008

Translational Research

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Methanol, ethylene glycol, and diethylene glycol intoxications can produce visual disturbances, neurological disturbances, acute renal failure, pulmonary dysfunction, cardiac dysfunction, metabolic acidosis, and death. Metabolic acidosis and an increased serum osmolality are important clues to their diagnosis. The former reflects the organic acids produced by metabolism of the parent alcohol, while the latter is due to accumulation of the offending alcohol. However, neither the clinical nor the laboratory findings are specific for toxic alcohol ingestions.The definitive diagnosis of the alcohol intoxications is commonly based on detection of the alcohol or its metabolites in blood. Early diagnosis is important, because initiation of appropriate treatment can markedly lessen their morbidity and mortality.At present detection of the parent alcohol in body fluids is inferred from its measurement in blood. This measurement is often performed by specialty laboratories using expensive equipment, and a long delay between obtaining the specimen and getting the results is not unusual. In this report, we describe liquid-based tests that detect methanol, ethylene glycol, diethylene glycol, and ethanol in saliva. The tests are sensitive and they have different specificity for each of the alcohols facilitating distinction among them. The relatively high sensitivity and specificity of the tests as a whole will facilitate the rapid diagnosis of each of these alcohol intoxications.

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“…Our patient’s case is unique because, to the best of our knowledge, this is the first case in the literature of transformer oil poisoning presenting with high osmolal gap, anion gap acidosis, and acute kidney injury mimicking acute methanol intoxication. Our patient posed a major diagnostic and treatment challenge because we were unaware that methanol is present in aged transformer oil and that the patient’s presentation can be similar to acute methanol intoxication [1]. …”

Section: Discussionmentioning

confidence: 99%

“…However, visual disturbance was not present in our patient. Rastogi et al reported a case of a patient with severe methanol intoxication after airplane fuel ingestion who did not experience any visual impairment and had no optic papillitis [1]. In another study, 37% of patients experienced visual disturbance with methanol intoxication [10].…”

Section: Discussionmentioning

confidence: 99%

Young man with severe metabolic acidosis after transformer oil ingestion: a case report

Khan

Zubair

2018

J Med Case Reports

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BackgroundTransformer oil is used in oil-filled transformers for its insulating as well as coolant properties. Transformer oil ingestion for attempted suicide is seldom heard of. Our patient’s case presented us with a major diagnostic as well as treatment challenge because we encountered such a case for the first time and were totally unaware of the fact that methanol might make up the main component of an aged transformer oil.Case presentationA 19-year-old Pakistani/Asian man was brought to our hospital with altered sensorium. He was found to have elevated anion gap acidosis, increased osmolal gap, and acute kidney injury. He had no evidence of rhabdomyolysis or hemolysis. Computed tomography of his head showed cerebral edema. He was resuscitated with intravenous fluids and bicarbonate. Three days later, he confessed taking transformer oil with suicidal intention. His clinical picture mimicked acute methanol intoxication. With an initial improvement in his neurological status, he started complaining of constant headache with episodes of agitation and delirium. His renal function continued worsening despite an adequate urine output. He showed a remarkable improvement in his neurological state after just one session of hemodialysis.ConclusionsThere is evidence that aged transformer oil contains methanol, and a patient who consumes it can present with features mimicking acute methanol intoxication.

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Spurious Elevation in Serum Creatinine Caused by Ingestion of Nitromethane: Implication for the Diagnosis and Treatment of Methanol Intoxication

Cited by 11 publications

References 22 publications

Can a spuriously raised creatinine by Jaffe method be helpful in poisoning?

Can a spuriously raised creatinine by Jaffe method be helpful in poisoning?

Simple diagnostic tests to detect toxic alcohol intoxications

Young man with severe metabolic acidosis after transformer oil ingestion: a case report

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