ethylene glycol intoxication

Etiology

• ingestion of ethylene glycol

Epidemiology

• ethylene glycol in found in antifreeze & de-icing solutions

Pathology

• when ingested, ethylene glycol is rapidly metabolized to oxalate
• calcium oxalate precipitation in renal tubules (nephrocalcinosis) & crystals in urine
• acute renal failure
• hypocalcemia
• cardiogenic shock
• neurotoxicity
• pulmonary edema

Clinical manifestations

• metabolic acidosis
• central nervous system dysfunction
• nephrocalcinosis (calcium oxalate cystals) - flank pain
• renal failure, hematuria, oliguria
• hypotension
• sweet, fruity breath

Laboratory

• anion gap metabolic acidosis
  • arterial blood gas
  • chem8 (calculate anion gap)
    • serum Na+
    • serum K+
    • serum bicarbonate (< 10 meq/L)
    • serum chloride
    • serum calcium, hypocalcemia
• serum ketones are negative
• serum osmolality, osmolal gap > 10 mOsm/kg H2O
• urinalyis:
  • hematuria
  • oxalate crystals in urine (rectangular)
• direct measurement of ethylene glycol in serum

Differential diagnosis

• methanol intoxication (renal manifestations not prominent feature)

Management

• fomepizole (Antizol) agent of choice
  • in conjunction with hemodialysis if evidence of renal injury or anion gap metabolic acidosis
• ethanol 10% solution
  • loading dose: 10 mL/kg
  • maintenance dose: 1.5 mL/kg
  • titrate to blood alcohol level of 22 mmol/L (100 mg/dL)
• hemodialysis
• sodium bicarbonate
• gastric decontamination with activated charcoal generally not useful*
• pyridoxine & thiamine
• ICU may be appropriate

* unless timing of large ingestion is known & decontamination can be performed within 1 hour of ingestion

More general terms

• alcohol toxicity

Additional terms

• ethylene glycol