An 18-year-old man who had been found unresponsive and face down in his bed after spending the day working in his garage is brought to the hospital emergency department.He had not responded to naloxone administration given by the paramedics.His history reveals that he was despondent over the recent death of his father,with whom he enjoyed restoring antique automobiles.Laboratory results indicate negative serum acetone,elevated serum urea and creatinine,normal PO₂,decreased bicarbonate,increased PCO₂,and increased osmol gap and anion gap.Urinalysis indicated many oxalate crystals.Based on these laboratory results and the likely compound that has affected this individual,what are the metabolizing enzyme and the metabolite(s)formed from the toxic compound?

Question

Quizplus · Accepted Answer

The negative serum acetone and normal PO₂ rule out alcohol and acetaminophen toxicity. The elevated serum urea and creatinine, decreased bicarbonate, increased PCO₂, increased osmol gap and anion gap, and oxalate crystals in the urinalysis suggest that the toxic compound is ethylene glycol, which is metabolized by alcohol dehydrogenase to glycolic acid and then to oxalic acid causing metabolic acidosis, renal failure, and calcium oxalate crystals in the urine.

An 18-Year-Old Man Who Had Been Found Unresponsive and Face