Related Subjects:
|Drug Toxicity - Assessment
|Metabolic acidosis
|Aspirin or Salicylates toxicity
|Ethylene glycol toxicity
|Ethanol toxicity
|Methanol toxicity
|Ricin toxicity
|Carbon Tetrachloride Toxicity
|Renal Tubular Acidosis
|Lactic acidosis
|Iron Toxicity
|Tricyclic Antidepressant Toxicity
|Opiate Toxicity
|Carbon monoxide Toxicity
|Benzodiazepine Toxicity
|Paracetamol (Acetaminophen) toxicity
|Amphetamine toxicity
|Beta Blocker toxicity
|Calcium channel blockers toxicity
|Cannabis toxicity
|Cyanide toxicity
|Digoxin Toxicity
|Lithium Toxicity
|NSAIDS Toxicity
|Ecstasy toxicity
|Paraquat toxicity
|Quinine toxicity
|SSRI Toxicity
|Theophylline Toxicity
|LSD Toxicity
|Organophosphate (OP) Toxicity
|Toxin elimination by dialysis
|Drug Toxicity with Specific Antidotes
Alcohol dehydrogenase inhibition is needed as quickly as possible by giving alcohol or fomepizole to prevent the metabolism of Ethylene Glycol to its toxic metabolites.
About
- Interesting as they are treatable and cause characteristic blood chemistry
- Ethylene Glycol is used as antifreeze in car radiators.
- Ethyl alcohol: replaced by fomepizole as a treatment of choice.
- It has been added to alcoholic drinks. Ethylene glycol tastes sweet
Related Articles
- Fomepizole
- Methanol toxicity
Aetiology
- Ethylene Glycol itself is harmless until metabolised
- First forms an aldehyde and then glyoxylic acid
- Metabolites cause renal failure (ATN) and a raised AG Metabolic acidosis
Clinical
- Coma and Convulsions, blindness
- Kussmaul respiration, Renal failure(ATN)
Investigations
- FBC, U&E - ↑ creatinine . ECG
- ABG: ↑↑ anion gap metabolic acidosis
- ↓ Hypocalcaemia
- Urine: calcium oxalate crystalluria
Management
- Advice on the treatment of ethylene glycol and methanol poisoning should be obtained from the National Poisons Information Service
- ABC, close monitoring, Oxygen to give sats of 94-98%. IV fluids to maintain good diuresis and flush kidneys of oxalate crystals. Consider IV bicarbonate to correct severe acidosis (pH level <7.2)
- Alcohol loading dose: of 50 g of ethanol (conveniently given as approximately 125 ml of gin, whisky, or vodka)* should be administered immediately orally
- IV (Ethyl) Alcohol infusion: intravenous infusion of ethanol to provide blood ethanol concentrations of 500 mg to 1 g/l. The infusion should be continued until ethylene glycol is no longer detectable in the blood.
- Keep a close watch on pH and Anion gap as well as ABG and renal function.
- Fomepizole: recommended if ethylene glycol serum levels > 20 mg/dl or if ingestion of ethylene glycol is suspected. If ethylene glycol levels are equal to or above 50 mg/dl, or when the patient has renal failure or worsening metabolic acidosis, haemodialysis should also be considered. Haemodialysis removes fomepizole, therefore doses must be given more frequently during haemodialysis.
- Consider haemodialysis as a treatment method and contact the local renal unit early and dialyse until no ethylene glycol is detectable in the blood. Indications include
pH < 7.25, Acute renal failure, Ethylene glycol level >50 mg/dl, Serum glycolic acid >8
- There may be an argument for IV NaHCO3 discuss with local poisons centre
References