Illness Script for Ethylene Glycol Intoxication: Patient with psychiatric history presents with combination of neurologic symptoms (hyporeflexia, depressed mental status), metabolic acidosis (classically high anion gap metabolic acidosis, see the G in GOLDMARK), and osmolar gap (Normal gap is <10). Additional findings include AKI with calcium oxalate crystals (above) on urine microscopy, fluorescence of bodily fluids on wood's lamp testing.
What is the differential diagnosis of calcium oxalate crystals? 1) Primary hyperoxaluria, 2) Ethylene glycol poisoning, 3) Secondary hyperoxaluria due to pancreatic insufficiency, inflammatory bowel disease, bowel resection, or gastric bypass, 4) Orlistat therapy, and 5) High doses of vitamin C.
Why use a Wood's lamp at all? A wood's lamp is essentially a black light. It can be obtained from the ED of your local hospital. To use the wood's lamp, find a dark room and turn the black light on. Dermatologists are classically those who use the wood's lamp the most frequently, typically in the diagnosis of erythrasma (coral red fluorescence) and tinea. However, two disorders can cause urine to fluoresce, those being porphyria cutaneous tarda (by excessive uroporphyrin excretion, pink-orange fluorescence) and ethylene glycol toxicity (by fluorescein in the mixture of antifreeze).