Ethylene glycol toxicity

Background

Common component of antifreeze

Yellow or green 2/2 fluorescein dye

Sweet taste

Pathophysiology

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

W/U

Accucheck

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

Serum osm

UA (calcium oxalate crystals = late finding)

ABG

Wood's Lamp

Ethylene glycol level (usually send-out)

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

Diagnosis

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