Ethylene glycol toxicity: Difference between revisions

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==Background==
== Background ==


*Component of antifreeze
*Toxic dose = 0.2mL/kg
*Letal dose = 1.4mL/kg
*Sweet taste
*Fluoresces yellow/green under Wood's lamp


Common component of antifreeze


Yellow or green 2/2 fluorescein dye


Sweet taste
== Pathophysiology ==


== ==
*Ethylene glycol + aldehyde dehydrogenase > oxalate + glycolic acid


== Work-Up ==


==Pathophysiology==
*Chemistry
**Anion gap acidosis
**Renal failure
**Osm gap
***Calculated serum osm = 2Na + BUN/2.8 + glucose/18 + ethanol/4.2)
**Serum Osm
*Glucose
*Ethanol level
*UA
**Hematuria, proteinuria, pyuria
**Calcium oxalate crystals (late finding, only seen in 50%)
**Urinary fluorescence (may be seen 6 hours after ingestion)
*Total CK
*VBG
*ECG
**QT prolongation ~ hypocalcemia


== Clinical Manifestations ==
*Patients may die in any stage!


Binds aldehyde dehydrogenase and leads to toxic metabolites including glycolic acid and oxalate


*Stage 1 - CNS
** 30min to 12h
** Pt appears intoxicated (slurred speech, ataxia, stupor, sz, coma)


==W/U==
*Stage 2 - Cardiopulmonary
** 12- 24h
** Hypertension, tachycardia, CHF
** ARDS, pulmonary infiltrates
** Hypocalcemia (chelation by oxalate)
** Myositis & CK elevation


*Stage 3 - Renal
** 24- 72h
** Flank pain, CVAT
** Hematuria, proteinuria, calcium oxalate crystals (50%)


Accucheck
*Stage 4 - Delayed CNS
** 6-12days
** Cranial neuropathy


Chem7 (renal failure; calculate serum osm = 2Na + BUN/2.8 + glucose/18 + ethanol/4.2)
== Treatment ==


Serum osm
1. Correction of metabolic acidosis with bicarbonate
* Bicarbonate 1-2mEq/kg IV bolus to attain pH = 7.45-7.50
** Follow by infusion of 150mEq/L in D5 @ 1.5-2 times maintenance fluid rate
* Monitor for worsening hypocalcemia


UA (calcium oxalate crystals = late finding)


ABG
2. ADH enzyme blockade
*Fomepizole (4-MP)
** 15mg/kg followed by 10mg/kg q12hr x 4 doses
*Ethyl alcohol


Wood's Lamp


Ethylene glycol level (usually send-out)
3. Removal of parent alcohol and metabolites via dialysis
*Indications (controversial):
** Severe acidosis (pH <7.30)
** Renal compromise
** Electrolyte imbalanes unreponsive to conventional therapy
** Anion gap > 20


4. Other
* Thiamine 100mg IV q6hr and Pyridoxine 50mg q6hr
**Theoretically decreases oxalate production
* Replace Magnesium
*Hypercalcemia
** Symptomatic - treat cautiously (avoid further precipitation)
** Asymptomatic - do not treat


*serum osm larger than expected: mathanol, ethylene glycol, acetone, isopropyl, propylene glycol


== Source ==


==Diagnosis==
Rosen's


 
<br/>[[Category:Tox]] <br/><br/>
Stage1- cns stage- 30min to 12h- pt appears intoxicated- slurred speech, ataxia, stupor, sz, coma
 
Stage 2- cardiopulmonary- 12- 24h, htn, tachycardia, chf, myositis
 
Stage 3- renal stage- 24- 72 h, flank pain, cvat, Ca ox
 
 
==Treatment==
 
 
Ethyl alcohol
 
Fomepizole (4-mp)
 
Hemodialysis:
 
-CNS or vision dysfxn
 
-severe acidosis (pH <7.15)
 
-methanol level above 20mg/dL
 
-ingestion > 30mL
 
== ==
 
 
==Source==
 
 
Tintinalli
 
 
 
 
[[Category:Tox]]

Revision as of 20:27, 21 March 2011

Background

  • Component of antifreeze
  • Toxic dose = 0.2mL/kg
  • Letal dose = 1.4mL/kg
  • Sweet taste
  • Fluoresces yellow/green under Wood's lamp


Pathophysiology

  • Ethylene glycol + aldehyde dehydrogenase > oxalate + glycolic acid

Work-Up

  • Chemistry
    • Anion gap acidosis
    • Renal failure
    • Osm gap
      • Calculated serum osm = 2Na + BUN/2.8 + glucose/18 + ethanol/4.2)
    • Serum Osm
  • Glucose
  • Ethanol level
  • UA
    • Hematuria, proteinuria, pyuria
    • Calcium oxalate crystals (late finding, only seen in 50%)
    • Urinary fluorescence (may be seen 6 hours after ingestion)
  • Total CK
  • VBG
  • ECG
    • QT prolongation ~ hypocalcemia

Clinical Manifestations

  • Patients may die in any stage!


  • Stage 1 - CNS
    • 30min to 12h
    • Pt appears intoxicated (slurred speech, ataxia, stupor, sz, coma)
  • Stage 2 - Cardiopulmonary
    • 12- 24h
    • Hypertension, tachycardia, CHF
    • ARDS, pulmonary infiltrates
    • Hypocalcemia (chelation by oxalate)
    • Myositis & CK elevation
  • Stage 3 - Renal
    • 24- 72h
    • Flank pain, CVAT
    • Hematuria, proteinuria, calcium oxalate crystals (50%)
  • Stage 4 - Delayed CNS
    • 6-12days
    • Cranial neuropathy

Treatment

1. Correction of metabolic acidosis with bicarbonate

  • Bicarbonate 1-2mEq/kg IV bolus to attain pH = 7.45-7.50
    • Follow by infusion of 150mEq/L in D5 @ 1.5-2 times maintenance fluid rate
  • Monitor for worsening hypocalcemia


2. ADH enzyme blockade

  • Fomepizole (4-MP)
    • 15mg/kg followed by 10mg/kg q12hr x 4 doses
  • Ethyl alcohol


3. Removal of parent alcohol and metabolites via dialysis

  • Indications (controversial):
    • Severe acidosis (pH <7.30)
    • Renal compromise
    • Electrolyte imbalanes unreponsive to conventional therapy
    • Anion gap > 20

4. Other

  • Thiamine 100mg IV q6hr and Pyridoxine 50mg q6hr
    • Theoretically decreases oxalate production
  • Replace Magnesium
  • Hypercalcemia
    • Symptomatic - treat cautiously (avoid further precipitation)
    • Asymptomatic - do not treat


Source

Rosen's




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