Ethylene Glycol Poisoning

In this article, we will discuss the Ethylene Glycol Poisoning. So, let’s get started.

Ethylene Glycol Poisoning

Ethylene glycol is a major constituent in most anti-freeze compounds. The toxicity is due to its metabolism to highly toxic organic acids, i.e. glycolic and oxalic acids. Diethylene glycol is nephrotoxic solvent that has been improperly substituted for glycerine in various liquid medications (cough syrup, teething medicine, acetaminophen) causing deaths.

Clinical Features

Features include confusion, severe anion gap, metabolic acidosis, tachypnea, convulsions and coma (similar to methanol poisoning). As it is nephrotoxic, hence, produces oxalate crystalluria and acute renal failure.

Treatment

  • Nasogastric aspiration and activated charcoal to remove the poison
  • Correction of fluid deficit by I.V. fluids
  • Treatment of metabolic acidosis (saline or osmotic diuresis, thiamine and pyridoxine supplementation and fomepizole) similar to methanol poisoning. Dialysis can be used in severe acidosis (pH <7.3 or osmolar gap exceeds 20 mOsm/kg).

Both ethyl alcohol and fomepizole compete for alcohol dehydrogenase with ethylene glycol. Both fomepizole and ethyl alcohol reduce the toxicity, hence ethanol I.V. should be infused to achieve blood level of 22 mmol/L (100 mg/dl) followed by infusion of fomepizole.

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