Moreover, if the contents of a substance are not known, diagnosis and treatment are further delayed. A combination of high anion gap metabolic acidosis and elevated osmolal gap often points to acute ethanol, methanol, or ethylene glycol poisoning that can be confirmed only by a history of ingestion of these products or positive blood tests. Diabetes mellitus is a metabolic disorder of multiple etiology characterized by chronic hyperglycemia with disturbances of carbohydrates, fat and protein metabolism resulting from a defect in insulin secretion, insulin resistance, or both. (WHO, 1999).. To the Editor.— Recently, a 24-year-old woman was admitted to our emergency ward in profound metabolic acidosis. This was associated with tonic seizures that ultimately proved to be a result of pure strychnine poisoning. The initial pH was 6.57 (checked and rechecked); Po 2,140 mm Hg; and Pco 2, 18 mm Hg.Blood lactate level was 177 mg/100 ml (normal, 0 to 16). Treatment: Insulin Guidelines for switching to subcutaneous injections of insulin: Serum glucose levels < 300mg/dL Resolved acidosis HCO 3 >16-18 Stable cardiopulmonary status Tolerating solid PO intake Recommendations: .5 U/kg SQ of which 1/3 Humalog and 2/3 intermediate acting (Lente or NPH) Give first dose prior to a meal.