(886) Falsely Elevated Ethanol Level due to Severe Lactic Acidosis

Introduction: In postmortem analysis, it is well known that elevated levels of lactate dehydrogenase can cross react in certain assays leading to falsely positive ethanol levels. This phenomenon has rarely been seen in vivo, especially in infants. Here we present the case of a two-month-old male admitted after cardiac arrest at home with falsely positive serum and urine ethanol levels.

Description: A two-month-old male was admitted after an out of hospital arrest. He had been found unresponsive at home after being put to sleep prone. ROSC was achieved in the ED where pupils were noted to be fixed and dilate. Initial pH was < 6.5 and temperature was < 33C. Clinical instability precluded head imaging, but there were no signs of external trauma.

Patient was noted to have a lactate level greater than 20, elevated WBC and LFTs as well as coagulopathy. Toxicology labs were sent, and initial serum ethanol level was 13. Two hours later, it was < 5. Initial urine studies were also sent at the time of the initial ethanol level but did not come back positive until the next day. The child advocacy team was then consulted. Repeat labs and urine were sent but this was after the patient had received hemodialysis for hyperkalemia.

The infant died from multi-system organ failure on day 3 of his hospitalization. Postmortem he was noted to have a skull fracture by the medical examiner. They also tested initial blood and urine samples which resulted negative for ethanol. Although his prestation may have been due to unsafe sleep practices, his death was ruled undetermined due to the presence of a skull fracture which may represent prior accidental trauma.

Discussion: Though the phenomenon of high levels of lactate dehydrogenase cross reacting with ethanol detection assays is well known in postmortem samples, it is very rarely seen in living samples. To our knowledge, there is only one published similar case. However, perhaps this can be explained by an extended down time leading to significantly increased lactate levels.

Given the occurrence of false positive ethanol levels is rare, maltreatment evaluations should always proceed for forensic purposes. Nevertheless, knowing that there is a possibility of cross-reactivity can aid in child protection investigations.