Ethylene Glycol Poisoning Without Fomepizole in a Regional Australian Intensive Care Unit: The Lactate Gap as the Diagnostic Key and the Consequences of Nasogastric Ethanol Therapy.

A 62-year-old man presented comatose with pH 6.88 and no ingestion history. A point-of-care lactate above 31 mmol/L with a laboratory lactate of 0.8 mmol/L revealed a lactate gap, diagnosing ethylene glycol poisoning despite a near-normal osmolar gap. High-dose continuous renal replacement therapy corrected the acidosis; he survived.