Ethylene Glycol Intoxication Requiring ECMO Support

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.

MANAGEMENT OF THE EMERGENCY DEPARTMENT PATIENT WITH TOXIC ALCOHOL POISONING

The aim of the study is to present the process of diagnosis and treatment of the patients poisoned with toxic alcohols. Furthermore, the suicide risk assessment was presented. The role of supportive cure and the importance of the treatment with alcohol dehydrogenase blockade with fomepizole or ethanol hemodialysis for severe intoxicated patients were presented. The differences in the treatment of poisoning with particular toxic alcohols were presented. Moreover, the important psychological factors in the management of this group of patients were also discussed. The paper was illustrated with typical case studies of patients suffering from methanol and ethylene glycol intoxication. Conclusions: 1. The recognition of toxic alcohol poisoning remains a challenge for the clinician, because nonspecific symptoms are similar in many other conditions. 2. Proper management of the poisoned patients requires thorough analysis of many aspects: circumstances of the event, laboratory findings, response to the treatment, and the patient’s psychological problems.

Fatal Ethylene Glycol Intoxication Secondary to Accidental Ingestion

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.