No abstract

Ethylene glycol is one of the most common toxic alcohol ingestions requiring hemodialysis for treatment. With the FDA approval in 1997 of fomepizole (4-methylpyrazole), the indications for hemodialysis in addition to fomepizole for ethylene glycol poisoning have been examined in recent articles and case reports. Fomepizole, a competitive inhibitor of alcohol dehydrogenase, binds to the same site on the enzyme as ethanol, however the pharmacokinetics of fomepizole are more predictable, and with fewer side effects compared to ethanol. Current guidelines cited in the literature for the use of hemodialysis in ethylene glycol poisoning include patients with severe metabolic acidosis (pH 7.3), serum ethylene glycol level 50 mg/dL, acute kidney injury, and deteriorating vital signs despite intensive care. This article is a review of the current literature with regard to the use of fomepizole as monotherapy for ethylene glycol poisoning, as well as the indications for hemodialysis in ethylene glycol poisoning.