Differential Diagnosis for Elevated Osmolal Gap
Single Most Likely Diagnosis
- Ethanol: Ethanol is a common and well-known cause of an elevated osmolal gap due to its osmotically active properties. It is frequently encountered in clinical practice, especially in patients with a history of alcohol consumption.
Other Likely Diagnoses
- Isopropyl alcohol: Similar to ethanol, isopropyl alcohol can cause an elevated osmolal gap. It is less common than ethanol but still a significant consideration, especially in cases of suspected ingestion.
- Methanol: Methanol is another alcohol that can increase the osmolal gap. Its ingestion is less common than ethanol but can have severe and potentially fatal consequences, making it an important consideration.
- Glucose: High levels of glucose, as seen in diabetic ketoacidosis or hyperglycemic hyperosmolar nonketotic syndrome, can also elevate the osmolal gap.
Do Not Miss Diagnoses
- Ethylene glycol: Ingestion of ethylene glycol, found in antifreeze and other products, can lead to a significant increase in the osmolal gap. It is crucial to consider this diagnosis due to its potential for severe renal and metabolic toxicity.
- Propylene glycol: Used as a solvent in various pharmaceutical preparations, propylene glycol can accumulate in patients receiving high doses of certain medications, leading to an elevated osmolal gap and potential toxicity.
Rare Diagnoses
- Sorbitol: Found in some sugar-free gums and candies, sorbitol can cause an elevated osmolal gap, although this is relatively rare and usually seen in the context of excessive consumption.
- Mannitol: Used in medical settings as an osmotic diuretic, mannitol can increase the osmolal gap. However, this is typically in a controlled environment and less likely to be a diagnostic challenge.
- Glycerol: Glycerol can also contribute to an elevated osmolal gap, though this is uncommon and usually related to specific medical treatments or ingestions.