Oxalate crystals. 2010 Jun. Ethylene glycol is only mildly irritating to skin and headache, dizziness, or a feeling of intoxication. If started before onset of acidosis, fomepizole may be used as the sole treatment for ethylene glycol ingestion in some cases. [Medline]. Abid A Kagalwalla, MD Resident Physician, Department of Emergency Medicine, St Joseph Mercy Hospital, University of Michigan Health System, Abid A Kagalwalla, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine. Method and Results. [Full Text]. Ascertain as much specific information regarding the identity of the ingested substance as possible. Hodgman M, Marraffa JM, Wojcik S, Grant W. Serum Calcium Concentration in Ethylene Glycol Poisoning. When administering ethanol, determine glucose levels by fingerstick collection at regular intervals and confirm with laboratory analysis, as hypoglycemia is occasionally associated with ethanol therapy. If you log out, you will be required to enter your username and password the next time you visit. 3:208-225. Brent J, McMartin K, Phillips S, et al. December 2010. Ad Hoc Committee. Ethyl alcohol has traditionally been used for antidotal treatment, but it has largely been supplanted by fomepizole in the United States. Background Ethylene glycol poisoning causes metabolic acidosis and renal failure and may cause death. 325451-overview October 21, 2014; Accessed: May 29, 2020. Carney EW. Consulting a nephrologist early in the intoxication is prudent to facilitate the timely initiation of dialysis to these patients. Saad Alkahtani, Helen Sammons, and Imti Choonara. Antidotal therapy is inadequate by itself in these circumstances, and dialysis should be performed as soon as possible. Diseases & Conditions, 2002 Persons exposed to ethylene glycol liquid or vapor do Acad Pathol. Gummin DD, Mowry JB, Spyker DA, Brooks DE, Beuhler MC, Rivers LJ, et al. Cheng JT, Beysolow TD, Kaul G, et al. Ad Hoc Committee. June 2009. Ingestion is the most important exposure route. Pathology 1995; 27:273. 2009 Jan. 55(1):46-9. ___________;__________. Diseases & Conditions, 2002 Predictors of Death and Prolonged Renal Insufficiency in Ethylene Glycol Poisoning. or by inhalation. Ethylene glycol toxicity presenting with non-anion gap metabolic acidosis. Divakar Jammalamadaka and Sina Raissi. Incorporation of therapeutic interventions in physiologically based pharmacokinetic modeling of human clinical case reports of accidental or intentional overdosing with ethylene glycol. not pose significant risks of secondary contamination to no risk of secondary contamination to hospital personnel. John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals antidote. Treatment of ethylene glycol poisoning with intravenous 4-methylpyrazole. Third, a history or suspicion of ethylene glycol intoxication and the presence of at least two of the following The availability of timely results of laboratory tests can be a problem. Ethylene Glycol, Methanol, and Isopropyl Alcohol Intoxication. Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT Associate Clinical Professor, Department of Surgery/Emergency Medicine and Toxicology, University of Texas School of Medicine at San Antonio; Medical and Managing Director, South Texas Poison Center J Toxicol Clin Toxicol. An IV catheter was placed in Max’s left front leg so that IV fluids could be administered to flush out any remaining ethylene glycol. John G Benitez, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Undersea and Hyperbaric Medical Society, Wilderness Medical Society, American College of Occupational and Environmental MedicineDisclosure: Nothing to disclose. Can Fam Physician. The American Journal of the Medical Sciences. 1999. [Medline]. In one case report, Note: Javascript is disabled or is not supported by your browser. Ingestion of ethylene glycol produces CNS depression Infuse the loading dose and the maintenance dose over the first hour of therapy. 53:1091-1097. In centers where fomepizole is available, patients who present early and are without acidosis clinically well can be treated with fomepizole and hemodialysis on a regular floor. can cause acidosis, hyperventilation, and renal failure An integrated perspective on the developmental toxicity of ethylene glycol. [Full Text]. Fomepizole is a comparatively newer agent with specific indication for ethylene glycol poisoning and has been approved by the US Food and Drug Administration [ 1. Krasowski MD. 85(1):491-501. [Medline]. Procedures, 2002 Weigh the benefits, risks, and costs of each therapeutic intervention at the treating institution. Ethylene glycol is a clear, odorless, slightly viscous liquid with a sweet taste. Activated charcoal and nasogastric lavage have no role in toxic alcohol poisoning; typically the alcohols will be absorbed too quickly for either of these modalities to have any efficacy. In the United States, contemporary treatment of this poisoning is most commonly done with fomepizole alone. Urine fluorescence using a Wood's lamp to detect the antifreeze additive sodium fluorescein: a qualitative adjunctive test in suspected ethylene glycol ingestions. [Full Text]. Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine, Texas Medical Association, American College of Occupational and Environmental MedicineDisclosure: Nothing to disclose. Treatment can include administration of ethanol or fomepizole, both inhibitors of the enzyme alcohol dehydrogenase to prevent formation of its metabolites, and hemodialysis to remove methanol and formate. 2009 Jan. 104 (1):22-6. Educational Case: Ethylene Glycol Poisoning. [Guideline] Barceloux DG, Krenzelok EP, Olson K, Watson W. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. 37(5):537-60. Arch Dis Child. [Guideline] Agency for Toxic Substances and Disease Registry. 53:1091-1097. . ATSDR. Place symptomatic patients in a monitored setting. [14] Fomepizole is administered with a loading dose and twice-daily intravenous dosing. Emergency medical services should do the following: Rapidly evaluate patients who present with signs, symptoms, or history of toxic alcohol ingestion; determine serum osmolal gap. Rapid recognition and early treatment, including alcohol dehydrogenase (ADH) inhibition, are crucial. chemical by contacting: ____________ or _____________, or by Any patients who are ill and acidotic or who present to centers where ethanol is used instead of fomepizole should be treated in an intensive care unit (ICU) or other setting with cardiac monitoring and close nursing care. A report of accidental ethylene glycol ingestion in 2 siblings. 2013 Dec 26. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. If ethylene glycol poisoning is suspected, begin antidotal therapy empirically while awaiting confirmation. Ghannoum M, Hoffman RS, Mowry JB, Lavergne V. Trends in toxic alcohol exposures in the United States from 2000 to 2013: a focus on the use of antidotes and extracorporeal treatments. A review of 121 ethylene glycol poisoning cases found that patients who did not receive an antidote (ethanol and/or fomepizole) until more than 6 hours had passed had higher odds of dying or having prolonged renal insufficiency (odds ratio 3.34). 1999; 37(5):537-60. Ad Hoc Committee. Barceloux DG, Krenzelok EP, Olson K, Watson W. J Toxicol Clin Toxicol. Treatment for ethylene glycol poisoning typically includes basic supportive care, alcohol dehydrogenase inhibition, and hemodialysis. 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