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Why does methanol and propylene glycol ingestion cause elevation of both while drug ingestion, e.g. salicylates or isoniazid only causes elevation of the former?
Think of the osmolal gap as an “unmeasured anion gap “ in that your standard anion gap calculation will not account for something like methanol and propylene glycol .Why does methanol and propylene glycol ingestion cause elevation of both while drug ingestion, e.g. salicylates or isoniazid only causes elevation of the former?
That being said as the methanol is metabolized to Formic acid and ethylene glycol is metabolized to oxalic acid (and glycine) , those components will no longer contribute to an osmolal gap and will begin to contribute to an anion gap .
If the “intrepid pgy2/3” decides to order osmolal gap a few days into the admission after reading mksap , uptodate , or pocket medicine , then the osmolal gap may not be present anymore .