Abstract
Introduction
Ethylene glycol is a widely used chemical that is capable of causing significant injury if ingested. Treatment for ethylene glycol poisoning typically includes basic supportive care, alcohol dehydrogenase inhibition, and hemodialysis. Recent data have suggested that hemodialysis may not be necessary for cases of ethylene glycol poisoning that can be treated with fomepizole as blocking therapy before acidosis or renal dysfunction develops.
Case Report
A 33-year-old man presented to the emergency department 1 hour after drinking approximately 1/2 gallon of ethylene glycol antifreeze and an unknown quantity of beer. On arrival he was mildly inebriated but otherwise displayed no other features of ethylene glycol poisoning. Fomepizole therapy was initiated and initial laboratory studies later revealed an osmol gap of 157 mOsm and an ethylene glycol concentration of 706 mg/dL. Nephrology and toxicology services were consulted. Over the next 3 days, fomepizole therapy was continued while the patient’s acid-base status and renal function were closely monitored. No evidence of acid-base abnormalities or renal impairment was ever observed and the patient was discharged to psychiatric care on the fourth hospital day.
Discussion
This report describes the case of a patient who presented soon after a massive ingestion of ethylene glycol with very high serum concentrations. He was successfully treated using fomepizole and basic supportive care. Our patient developed neither renal insufficiency nor metabolic acidosis. His concomitant ethanol consumption, early presentation, and treatment likely contributed to his favorable outcome. This case report underscores the effectiveness of supportive care and fomepizole in the treatment of ethylene glycol poisoning.
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Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System.Am J Emerg Med 2004;22(5):335–404.
Barceloux DG, Krenzelok EP, Olson K, et al. American Academy of Clinical Toxicology practice guidelines on the treatment of ethylene glycol poisoning. Ad hoc committee.J Toxicol Clin Toxicol. 1999;37(5):537–560.
Glaser DS. Utility of the serum osmol gap in the diagnosis of methanol or ethylene glycol ingestion.Ann Emerg Med. 1996;27(3):343–346.
Brent J, McMartin K, Phillips S, et al. Fomepizole for the treatment of ethylene glycol poisoning. Methylpyrazole for Toxic Alcohols Study Group.N Engl J Med. 1999;340(11):832–838.
Anonymous. Ethylene glycol antidote cleared for marketing. (News)Am J Health Syst Pharm. 1998;55(2):110.
Joliff H, Sivilotti M. Ethylene glycol. In: Dart RC, editor. Medical Toxicology. Philadelphia: Lippincott Williams & Wilkins;2004. pp. 1229–1230.
Baud FJ, Bismuth C, Garnier R, et al. 4-Methylpyrazole may be an alternative to ethanol therapy for ethylene glycol intoxication in man.J Toxicol Clin Toxicol. 1986;24(6):463–483.
Sivilotti ML, Burns MJ, McMartin KE, et al. Toxicokinetics of ethylene glycol during fomepizole therapy: Implications for management. For the Methylpyrazole for Toxic Alcohols Study Group.Ann Emerg Med. 2000;36(2):114–125.
Hantson P, Hassoun A, Mahieu P. Ethylene glycol poisoning treated by intravenous 4-methylpyrazole.Intensive Care Med. 1998;24(7):736–739.
Najafi CC, Hertko LJ, Leikin JB, et al. Fomepizole in ethylene glycol intoxication. AnnEmerg Med. 2001;37(3): 358–359.
Baud FJ, Galliot M, Astier A, et al. Treatment of ethylene glycol poisoning with intravenous 4-methylpyrazole.N Engl J Med. 1988;319(2):97–100.
Borron SW, Megarbane B, Baud FJ. Fomepizole in treatment of uncomplicated ethylene glycol poisoning.Lancet.1999;354(9181):831.
Boyer EW, Mejia M, Woolf A, et al. Severe ethylene glycol ingestion treated without hemodialysis.Pediatrics.2001;107(1):172–173.
Harry P, Jobard E, Briand M, et al. Ethylene glycol poisoning in a child treated with 4-methylpyrazole.Pediatrics.1998;102(3):E31.
Aakervik O, Svendsen J, Jacobsen D. [Severe ethylene glycol poisoning treated with fomepizole (4-methylpyrazole)].Tidsskr Nor Laegeforen.2002;122(25):2444–2446.
Davis DP, Bramwell KJ, Hamilton RS, et al. Ethylene glycol poisoning: Case report of a record-high level and a review.J Emerg Med.1997;15(5):653–667.
Curtin L, Kraner J, Wine H, et al. Complete recovery after massive ethylene glycol ingestion.Arch Intern Med. 1992;152(6):1311–1313.
Johnson B, Meggs WJ, Bentzel CJ. Emergency department hemodialysis in a case of severe ethylene glycol poisoning.Ann Emerg Med. 1999;33(1):108–110.
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Velez, L.I., Shepherd, G., Lee, Y.C. et al. Ethylene glycol ingestion treated only with fomepizole. J. Med. Toxicol. 3, 125–128 (2007). https://doi.org/10.1007/BF03160922
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DOI: https://doi.org/10.1007/BF03160922