Ethylene glycol intoxication presenting with high anion gap metabolic acidosis, acute kidney injury and elevated lactate

2018 ◽  
Vol 60 (2) ◽  
pp. 194-195 ◽  
Author(s):  
Thomas Giner ◽  
Violeta Ojinaga ◽  
Nikolaus Neu ◽  
Miriam Koessler ◽  
Gerard Cortina
Keyword(s):  
Acute Kidney Injury ◽  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Kidney Injury ◽  
Anion Gap ◽  
Ethylene Glycol Intoxication ◽  
Elevated Lactate

scholarly journals Ethylene Glycol Intoxication Requiring ECMO Support

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Raphael Rosen ◽  
Shelief Robbins-Juarez ◽  
Jacob Stevens
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Extracorporeal Membrane Oxygenation ◽  
Kidney Injury ◽  
Neurological Injury ◽  
Severe Metabolic Acidosis ◽  
Toxic Metabolites ◽  
Ethylene Glycol Intoxication

Ethylene glycol is commonly used in antifreeze, and ingestion of even a small amount can result in acute kidney injury, severe metabolic acidosis, and neurological injury. When cases are recognized early, treatment involves administration of alcohol dehydrogenase inhibitors to prevent conversion to toxic metabolites of glycolate, glyoxolate, and oxalate. In later presentations with more severe renal injury, hemodialysis may be required for clearance of toxic metabolites and supportive care for renal failure. We present the first reported case of severe ethylene glycol intoxication requiring support of extracorporeal membrane oxygenation (ECMO) due to refractory cardiopulmonary collapse.

scholarly journals Successful Resuscitation of a Patient with Life-Threatening Metabolic Acidosis by Hemodialysis: A Case of Ethylene Glycol Intoxication

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Ikuyo Narita ◽  
Michiko Shimada ◽  
Norio Nakamura ◽  
Reiichi Murakami ◽  
Takeshi Fujita ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Kidney Injury ◽  
University Hospital ◽  
Severe Metabolic Acidosis ◽  
Continuous Hemodiafiltration ◽  
Successful Resuscitation ◽  
Life Threatening ◽  
Ethylene Glycol Intoxication

Background. Ethylene glycol intoxication causes severe metabolic acidosis and acute kidney injury. Fomepizole has become available as its antidote. Nevertheless, a prompt diagnosis is not easy because patients are often unconscious. Here we present a case of ethylene glycol intoxication who successfully recovered with prompt hemodialysis. Case Presentation. A 52-year-old Japanese male was admitted to a local hospital due to suspected food poisoning. The patient presented with nausea and vomiting, but his condition rapidly deteriorated, with worsening conscious level, respiratory distress requiring mechanical ventilation, hypotension, and severe acute kidney injury. He was transferred to the university hospital; hemodialysis was initiated because of hyperkalemia and severe metabolic acidosis. On recovering consciousness, he admitted having ingested antifreeze solution. Thirty-seven days after admission, the patient was discharged without requiring HD. Conclusions. We reported a case of ethylene glycol intoxication who presented with a life-threatening metabolic acidosis. In a state of severe circulatory shock requiring catecholamines, hemodialysis should be avoided, and continuous hemodiafiltration may be a preferred approach. However, one should be aware of the possibility of intoxication by unknown causes, and hemodialysis could be life-saving with its superior ability to remove toxic materials in such cases.

scholarly journals A Case of Chronic Ethylene Glycol Intoxication Presenting without Classic Metabolic Derangements

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Stephanie M. Toth-Manikowski ◽  
Hanni Menn-Josephy ◽  
Jasvinder Bhatia
Keyword(s):  
Acute Kidney Injury ◽  
Ethylene Glycol ◽  
Kidney Biopsy ◽  
Kidney Injury ◽  
Altered Mental Status ◽  
Chronic Ingestion ◽  
Exposure History ◽  
Ethylene Glycol Intoxication ◽  
Physical Findings ◽  
Osmolar Gap

Acute ethylene glycol ingestion classically presents with high anion gap acidosis, elevated osmolar gap, altered mental status, and acute renal failure. However, chronic ingestion of ethylene glycol is a challenging diagnosis that can present as acute kidney injury with subtle physical findings and without the classic metabolic derangements. We present a case of chronic ethylene glycol ingestion in a patient who presented with acute kidney injury and repeated denials of an exposure history. Kidney biopsy was critical to the elucidation of the cause of his worsening renal function.

Metabolic acidosis with increased anion gap, oxaluria, and acute kidney injury: Answers

2020 ◽  
Author(s):  
Bagdagul Aksu ◽  
Erkin Rahimov ◽  
Alev Yilmaz ◽  
Zeynep Yuruk Yildirim ◽  
Ilmay Bilge ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Metabolic Acidosis ◽  
Kidney Injury ◽  
Anion Gap

Metabolic acidosis with increased anion gap, oxaluria, and acute kidney injury: Questions

2020 ◽  
Author(s):  
Bagdagul Aksu ◽  
Erkin Rahimov ◽  
Alev Yilmaz ◽  
Zeynep Yuruk Yildirim ◽  
Ilmay Bilge ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Metabolic Acidosis ◽  
Kidney Injury ◽  
Anion Gap

scholarly journals Acute kidney injury with oxalate deposition in a patient with a high anion gap metabolic acidosis and a normal osmolal gap

2013 ◽  
Vol 2 (2) ◽  
pp. 139-143 ◽  
Author(s):  
Tarek Alhamad ◽  
Jimena Blandon ◽  
Ana T. Meza ◽  
Jorge E. Bilbao ◽  
German T. Hernandez
Keyword(s):  
Acute Kidney Injury ◽  
Metabolic Acidosis ◽  
Kidney Injury ◽  
Anion Gap ◽  
Osmolal Gap

scholarly journals Ethylene Glycol Poisoning: An Unusual Cause of Altered Mental Status and the Lessons Learned from Management of the Disease in the Acute Setting

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
R. Singh ◽  
E. Arain ◽  
A. Buth ◽  
J. Kado ◽  
A. Soubani ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Mental Status ◽  
Kidney Injury ◽  
Altered Mental Status ◽  
Lessons Learned ◽  
Anion Gap ◽  
Tubular Damage ◽  
Elderly Male ◽  
Laboratory Findings

Ethylene glycol is found in many household products and is a common toxic ingestion. Acute ingestions present with altered sensorium and an osmolal gap. The true toxicity of ethylene glycol is mediated by its metabolites, which are responsible for the increased anion gap metabolic acidosis, renal tubular damage, and crystalluria seen later in ingestions. Early intervention is key; however, diagnosis is often delayed, especially in elderly patients presenting with altered mental status. There are several laboratory tests which can be exploited for the diagnosis, quantification of ingestion, and monitoring of treatment, including the lactate and osmolal gaps. As methods of direct measurement of ethylene glycol are often not readily available, it is important to have a high degree of suspicion based on these indirect laboratory findings. Mainstay of treatment is bicarbonate, fomepizole or ethanol, and, often, hemodialysis. A validated equation can be used to estimate necessary duration of hemodialysis, and even if direct measurements of ethylene glycol are not available, monitoring for the closure of the anion, lactate, and osmolal gaps can guide treatment. We present the case of an elderly male with altered mental status, acute kidney injury, elevated anion gap metabolic acidosis, and profound lactate and osmolal gaps.

Recurrent severe anion gap metabolic acidosis secondary to episodic ethylene glycol intoxication

2003 ◽  
Vol 60 (09) ◽  
pp. 205-210 ◽  
Author(s):  
S. Moossavi ◽  
N.K. Wadhwa ◽  
E.P. Nord
Keyword(s):  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Anion Gap ◽  
Ethylene Glycol Intoxication

scholarly journals Anion gap‐opening metabolic acidosis and urinary findings in the early diagnosis of ethylene glycol poisoning: A case report

2022 ◽  
Vol 10 (1) ◽  
Author(s):  
Kentaro Ukita ◽  
Kanako Otomune ◽  
Ryo Fujimoto ◽  
Kanako Hasegawa ◽  
Koichi Izumikawa ◽  
...  
Keyword(s):  
Case Report ◽  
Metabolic Acidosis ◽  
Early Diagnosis ◽  
Ethylene Glycol ◽  
Anion Gap ◽  
Ethylene Glycol Poisoning ◽  
Gap Opening
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