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 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.

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 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.

Ethylene Glycol Intoxication

1992 ◽  
Vol 7 (5) ◽  
pp. 234-243 ◽  
Author(s):  
James A. Kruse
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Specific Treatment ◽  
Severe Metabolic Acidosis ◽  
Presumptive Diagnosis ◽  
Cardiorespiratory Failure ◽  
Toxic Metabolites ◽  
Ethylene Glycol Intoxication

Commonly available as automotive antifreeze, ethylene glycol can cause toxicity and death if ingested. It is metabolized to several aldehyde and acid intermediates that can cause severe metabolic acidosis, central nervous system derangements, cardiorespiratory failure, and acute renal failure. A presumptive diagnosis can often be made by assessment of the anion gap and the osmol gap and the finding of metabolic acidosis. Corroborating findings include oxalate crystalluria and urine that fluoresces on exposure to ultraviolet light. Recognition is important because there are specific treatment methods available. Therapy consists of administering sodium bicarbonate to counter the acidosis, ethanol to slow the generation of toxic metabolites, and vitamin cofactors, which may speed detoxification of these intermediates. Hemodialysis is employed to remove both ethylene glycol and its metabolites, to correct the acidbase disturbances, and as treatment for acute renal failure.

Fatal Ethylene Glycol Intoxication Secondary to Accidental Ingestion

2017 ◽  
Vol 68 (7) ◽  
pp. 1591-1594 ◽  
Author(s):  
Cristina Furnica ◽  
Anton Knieling ◽  
Simona Irina Damian ◽  
Madalina Diac ◽  
Sofia David ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Calcium Oxalate ◽  
Histopathological Examination ◽  
Glyoxylic Acid ◽  
Calcium Oxalate Crystals ◽  
Severe Metabolic Acidosis ◽  
Histopathological Findings ◽  
Oxalate Crystals ◽  
Ethylene Glycol Intoxication

Ethylene glycol intoxication is potentially fatal and associated with typical clinical, laboratory and histopathological findings. The authors present the case of a 57-year-old male with a history of chronic alcoholism and who accidentally ingested approximately 1 litter of antifreeze solution. The patient was discovered comatose in his house and addressed to the emergency department with a Glasgow coma score of 3, severe metabolic acidosis, acute renal failure, atrial fibrillation and liver dysfunction. Despite reanimation manoeuvres and haemodialysis for 2 h the patient deceased 5 h after hospital admission. Necropsy examination revealed a stomach with oedematous walls, mucosa erosions and signs of bleeding together with a disorganised, granular single kidney with unidentifiable corticomedullary border. Histopathological examination displayed typical findings in the kidney such as autolytic changes of the epithelium and abundant calcium oxalate crystals in the lumen of the proximal tubules. Ethylene glycol intoxication is frequent in our country and its metabolites glycoaldehyde, glycolic acid, glyoxylic acid and oxalic acid are responsible for the severe metabolic acidosis and formation of calcium oxalate crystals in various organs and leading to severe multiple organ dysfunction and death. Forensic pathologists should be aware of clinical and biological manifestations as well as of typical histopathological findings as ethylene glycol is commonly ingested accidentally or used in homicidal/autolytical attempts.

scholarly journals Identifying Prognostic Factors of Severe Metabolic Acidosis and Acute Kidney Injury in African Children with Severe Falciparum Malaria: A Secondary Analysis of A Randomised Trial

2021 ◽  
Author(s):  
Grace Wezi Mzumara ◽  
Stije Stije Leopold ◽  
Kevin Marsh ◽  
Arjen Dondorp ◽  
Eric Ohuma ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Prognostic Factors ◽  
Metabolic Acidosis ◽  
Falciparum Malaria ◽  
Kidney Injury ◽  
Severe Anaemia ◽  
Severe Metabolic Acidosis ◽  
Prognostic Features ◽  
African Children ◽  
Severe Falciparum Malaria

Abstract IntroductionSevere metabolic acidosis and acute kidney injury are major causes of mortality in children with severe malaria but are often underdiagnosed in low resource settings. MethodsWe conducted a retrospective analysis of the ‘Artesunate vs Quinine in the treatment of severe falciparum malaria in African children’ (AQUAMAT) trial to identify clinical features of severe metabolic acidosis and acute kidney injury in 5425 children from nine African countries. Separate models were fitted for acute kidney injury and severe metabolic acidosis. Separate univariable and multivariable logistic regression were performed to identify prognostic factors for severe metabolic acidosis (SMA) and acute kidney injury (AKI). Both analyses adjusted for the trial arm. A forward selection approach was used for model building of the logistic models and a threshold of 5% statistical significance was used for inclusion of variables into the final logistic model. Model performance was assessed through calibration, discrimination, and internal validation with bootstrapping. ResultsThere were 2296 children identified with Severe metabolic acidosis and 1110 with Acute Kidney Injury. Prognostic features of SMA among them were: deep breathing (OR: 5.41, CI: 4.26 – 6.89), hypoglycaemia (OR: 5.22, CI: 3.80 – 7.18), AKI (OR: 3.99, CI: 3.30 – 4.81), coma ( OR: 1.79 CI: 1.36 – 2.35), respiratory distress (OR: 1.49, CI: 1.21 – 1.83), prostration (OR: 1.64 CI: 1.30 – 2.03) and severe anaemia (OR: 1.40, CI: 1.11 – 1.77). Features associated with AKI were; older children(OR: 1.20, CI: 1.15 – 1.25), coma (2.47, CI: 1.78 – 3.42), Prostration (OR: 1.52 CI: 1.14 – 2.02), decompensated shock (OR: 1.74, CI: 1.15 – 2.63), black water fever (CI: 1.81. CI: 1.22 – 2.69), jaundice (OR: 3.31 CI: 2.01 – 5.47), SMA (OR: 4.02 CI:3.30 – 4.89), mild anaemia (OR: 1.36, CI: 1.05 – 1.76), severe anaemia (OR: 1.48, CI: 1.11 – 1.96), hypoglycaemia (OR: 2.02, CI: 1.58 – 2.59), hypernatremia (OR: 5.74, CI: 2.69 – 12.26) and hyperkalaemia (OR: 5.31. CI: 4.15 – 6.80). ConclusionClinical and laboratory parameters representing contributors and consequences of severe metabolic acidosis and acute kidney injury were independently associated with these outcomes. The model can be useful for identifying patients at high risk of these complications where laboratory assessments are not routinely available.

scholarly journals A study on clinical profile of paraquat poisoning in a tertiary care hospital

2017 ◽  
Vol 4 (4) ◽  
pp. 1088
Author(s):  
Jagadeesan M. ◽  
Nithyananthan P. ◽  
Banupriya M. ◽  
Mahendrakumar K. ◽  
Prasanna Karthik S. ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Metabolic Acidosis ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Mortality Rates ◽  
Care Hospital ◽  
Paraquat Poisoning ◽  
Hospital Patients ◽  
Life Threatening ◽  
Overall Mortality

Background: Paraquat poisoning is a weedicide used rarely for suicide. It is now being increasingly as this type of suicidal poisoning is almost always fatal as there is no specific antidote for paraquat poison. ARDS, acute kidney injury with metabolic acidosis or multi-organ failure are the frequent causes of mortality.Methods: The study aimed to study the morbidity and mortality rates of Paraquat poisoning in tertiary care teaching hospital. Patients admitted with Paraquat poisoning were included, and the data were collected and analysed.Results: The total number of cases admitted with paraquat poisoning in intensive care unit in three years duration were 10. All the cases were suicidal in nature. 80% of the cases had acute kidney injury with severe metabolic acidosis and 20% had mediastinitis. 70% of cases died within 48 hours of ingestion. The overall mortality rate was 100% in spite of active management.Conclusions: Of all registered herbicides, Paraquat is the most serious and life threatening. Inspite of early haemodialysis, steroids and cyclophosphamide therapy, it was ineffective in reducing the mortality rates. Newer treatment like early hemoperfusion may help to reduce the mortality in future. 

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