scholarly journals CONCOMITANT INGESTION OF ETHYLENE GLYCOL AND ETHANOL: A DIAGNOSIS TRAP?

2015 ◽  
Vol 64 (3) ◽  
pp. 282-284
Author(s):  
Otilia-Elena Frasinariu ◽  
◽  
Aniela Rugina ◽  
Cristina Jitareanu ◽  
Radu Russu ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Severe Metabolic Acidosis ◽  
Subsequent Evolution ◽  
Positive History ◽  
Toxic Metabolites ◽  
Central Nervous System Depression ◽  
Ethylene Glycol Poisoning ◽  
Suicidal Attempts ◽  
Rule Out

Ethylene glycol is one of the most toxic alcohols; it may be accidentally or intentionally consumed as a substitute for ethanol or related to suicidal attempts. Ingestion of ethylene glycol causes a severe metabolic acidosis with increased anion and osmotic gap due to its toxic metabolites, leading to a clinical picture of central nervous system depression, cardiovascular and renal impairment. A 16-year-old boy was admitted with clinical and biological signs of ethylene glycol poisoning after simultaneous ingestion of antifreeze and ethanol. The patient had mild anion gap metabolic acidosis only at the debut, rapidly corrected with one dose of sodium bicarbonate; further evaluation did not reveal acidosis, even if the subsequent evolution included acute renal failure requiring hemodialysis. Due to the absence of a positive history and of a persistent metabolic acidosis, the diagnosis of ethylene glycol poisoning was delayed until it was confirmed by serum toxicological test. Conclusions: concomitant ingestion of ethanol may mask the symptoms of ethylene glycol poisoning; the absence of persistent metabolic acidosis does not rule out the diagnosis.

scholarly journals Lactate Gap: A Diagnostic Support in Severe Metabolic Acidosis of Unknown Origin

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Linn E. Hauvik ◽  
Mercy Varghese ◽  
Erik W. Nielsen
Keyword(s):  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Point Of Care ◽  
Unknown Origin ◽  
Medical Emergency ◽  
Severe Metabolic Acidosis ◽  
Ethylene Glycol Poisoning ◽  
The Difference ◽  
Lactate Levels ◽  
Elevated Lactate

Ethylene glycol poisoning is a medical emergency. The metabolites glycolate and glyoxylate give metabolic acidosis. Because of similar structure, these metabolites are misinterpreted as lactate by many point-of-care blood gas analyzers. The falsely high lactate values can lead to misdiagnosis, inappropriate laparotomies, and delayed antidotal therapy. As laboratory analyzers measure plasma lactate only, the difference or the “lactate gap” aids in early diagnosis. We present a patient with severe metabolic acidosis and elevated lactate levels on the point-of-care analyzer. A lactate gap supported the diagnosis of ethylene glycol poisoning. Hemodialysis and fomepizole treatment could be started immediately.

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.

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 Acidosis and coma after hemodialysis.

1997 ◽  
Vol 8 (5) ◽  
pp. 853-856
Author(s):  
R Taylor ◽  
J Bower ◽  
M M Salem
Keyword(s):  
Metabolic Acidosis ◽  
Ethylene Glycol ◽  
Suicide Attempts ◽  
Altered Mental Status ◽  
Anion Gap ◽  
Toxic Metabolites ◽  
Ethylene Glycol Poisoning ◽  
Rapid Clearance ◽  
Dialysate Solution ◽  
Osmolal Gap

Ethylene glycol poisoning is a rare yet potentially fatal illness seen most commonly in association with ingestion by alcoholics or in suicide attempts. It is characterized by an elevated anion gap metabolic acidosis, osmolal gap, calcium oxalate crystals in the urine, and a well-defined clinical picture. Prompt treatment is crucial because effective intervention can prevent the neurologic, cardiac, pulmonary, and renal sequelae associated with ethylene glycol poisoning. Hemodialysis offers rapid clearance of ethylene glycol and its toxic metabolites. In this article, the case of a hemodialysis patient who suffered contamination of the dialysate solution with ethylene glycol, leading to altered mental status, coma, and severe anion gap metabolic acidosis, is reported. Despite prolonged dialysis and correction of the acidosis, the patient remained comatose and subsequently died.

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

scholarly journals Treatment of Ethylene Glycol Poisoning with Oral Ethyl Alcohol

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
B. Achappa ◽  
D. Madi ◽  
T. Kanchan ◽  
N. K. Kishanlal
Keyword(s):  
Oxalic Acid ◽  
Ethylene Glycol ◽  
Ethyl Alcohol ◽  
Glycolic Acid ◽  
Clinical Suspicion ◽  
Toxic Metabolites ◽  
Ethylene Glycol Poisoning ◽  
High Degree

Ethylene glycol poisoning is not uncommon in India. The ill effects are primarily caused by its toxic metabolites: glycolic acid and oxalic acid. A 70-year-old female presented to our hospital with ataxia after ingestion of ethylene glycol. The reported case describes the management of ethylene glycol poisoning using oral ethyl alcohol as an alternative to the recommended intravenous ethyl alcohol and fomepizole that are not available for use in India. The need for high degree of clinical suspicion, targeted investigations, and early instigation of treatment is of prime importance in cases of ethylene glycol poisoning as it can lead to long-term complications or even death.

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