Teaching Pearls: 

• Calculate the osmolar gap in patients with an anion gap acidosis of unknown etiology. Causes of Elevated Osmolar Gap includes methanol, ethanol, ethylene glycol, propylene glycol, isopropyl alcohol, mannitol. Remember that Isopropyl alcohol causes an osmolar gap without an anion gap.
• The cough syrup/drug “Lean” can sometimes contain propylene glycol.
• Causes of Rhabdomyolysis includes:
  • Direct Injury/Trauma: Lightning strike, malignant hyperthermia, NMS, ischemic limb injury, exertional causes such as marathon running
  • Infectious: Viral, bacterial
  • Inflammatory: Polymyositis, dermatomyositis
  • Metabolic/Endocrinological: Electrolyte imbalance, hypothyroidism, thyrotoxicosis, DKA
  • Genetic Causes
• The treatment of Rhabdomyolysis includes fluid resuscitation and intravenous bicarbonate to alkalanize the urine to prevent myoglobin toxicity