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Ethylene glycol poisoning is associated with metabolic acidosis. As the history is often unclear and ethylene glycol analysis may not be available, the diagnosis has to rely on clinical signs. Osmolal gap, serum creatinine and urine oxalate crystals may be helpful. Blood lactate is routinely assayed in metabolic acidosis. As some laboratory equipment cannot distinguish between lactate and glycolate (metabolite of ethylene glycol), a high lactate level may in reality reflect glycolate accumulation. Hence lack of obvious reasons for a clearly elevated lactate should raise suspicion of a »false« lactate level and possible ethylene glycol ingestion. If lactate as a complement is measured by a method able to distinguish between lactate and glycolate and is found to be low, the diagnosis is most probably established. A large difference between two consecutive lactate values is named »lactate gap«. Two cases are reported where this analytical mix-up gave correct diagnosis.

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