Acute polyradiculoneuropathy with renal failure: mind the anion gap

Alzouebi, Mymoona; Sarrigiannis, Ptolemaios G.; Hadjivassiliou, Marios

doi:10.1136/jnnp.2008.144915

Cited by 7 publications

(3 citation statements)

References 14 publications

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“…CT brain tends to be normal but magnetic resonance imaging may show abnormal enhancement of cranial nerve nuclei [ 6 , 7 ]. Neurophysiology may show a primary axonal polyneuropathy [ 5 , 7 ], a primary demyelinating pathology [ 9 ], or a polyradiculopathy [ 10 , 11 ]. There has been one other case report that mentions the findings of bilateral perinephric stranding on CT in the context of diethylene glycol poisoning [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Delayed ethylene glycol poisoning presenting with abdominal pain and multiple cranial and peripheral neuropathies: a case report

Baldwin

Sran

2010

J Med Case Reports

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IntroductionEthylene glycol poisoning may pose diagnostic difficulties if the history of ingestion is not volunteered, or if the presentation is delayed. This is because the biochemical features of high anion-gap metabolic acidosis and an osmolar gap resolve within 24 to 72 hours as the ethylene glycol is metabolized to toxic metabolites. This case illustrates the less well-known clinical features of delayed ethylene glycol poisoning, including multiple cranial and peripheral neuropathies, and the clinical findings which may point towards this diagnosis in the absence of a history of ingestion.Case presentationA 53-year-old Afro-Caribbean man presented with vomiting, abdominal pain and oliguria, and was found to have acute renal failure requiring emergency hemofiltration, and raised inflammatory markers. Computed tomography imaging of the abdomen revealed the appearance of bilateral pyelonephritis, however he failed to improve with broad-spectrum antibiotics, and subsequently developed multiple cranial neuropathies and increasing obtundation, necessitating intubation and ventilation. Computed tomography of the brain showed no focal lesions, and a lumbar puncture revealed a raised cerebrospinal fluid opening pressure and cyto-albuminological dissociation. Nerve conduction studies revealed a sensorimotor radiculoneuropathy mimicking a Guillain-Barre type lesion with an atypical distribution. It was only about two weeks after presentation that the history of ethylene glycol ingestion one week before presentation was confirmed. He had a slow recovery on the intensive care unit, requiring renal replacement therapy for eight weeks, and complicated by acute respiratory distress syndrome, neuropathic pain and a slow neurological recovery requiring prolonged rehabilitation.ConclusionsAlthough neuropathy as a result of ethylene glycol poisoning has been described in a few case reports, all of these were in the context of a known history of ingestion. As the diagnosis may well be obscured if the history of ingestion is not elucidated, it is important to be aware of this possibility especially if presentation is delayed.

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Section: Discussionmentioning

confidence: 99%

Delayed ethylene glycol poisoning presenting with abdominal pain and multiple cranial and peripheral neuropathies: a case report

Baldwin

Sran

2010

J Med Case Reports

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“…2,5 Here, we report a patient who attempted suicide by the ingesting EG and developed a delayed neurological deficit mimicking fulminant GBS. Serial electrophysiological evaluation and clinical outcomes are described to speculate the main pathophysiology of EG-related neuropathy.…”

Section: Introductionmentioning

confidence: 99%

“…It is often associated with limb weakness, areflexia, and CSF albuminologic dissociation, mimicking GuillianBarre Syndrome (GBS). [2][3][4][5] However, the main pathophysiology of EG-related neuropathy is uncertain because few studies regarding sequential electrophysiological study or postmortem pathologic study for EG-related neuropathy have been performed.…”

Section: Introductionmentioning

confidence: 99%

Multiple Cranial Neuropathy with and Polyradiculoneuropathy as a Delayed Sequelae after of Ethylene Glycol Intoxication

Kim

Kwon

et al. 2013

Korean J Clin Neurophysiol

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Multiple cranial and peripheral neuropathies as a delayed sequellae of ethylene glycol poisoning is a less well known clinical entity and its information about long-term electrophysiological and clinical outcomes is limited. We report a 45-year-old male who presented with acute renal failure and subsequently developed multiple cranial neuropathy, respiratory failure, and flaccid tetraparesis. Through sequential electrophysiological studies, we would like suggest that the main pathophysiology of ethylene glycol-related neuropathy is a demyelinating polyradiculoneuropathy with secondary axonal degeneration.

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Toxic alcohol diagnosis and management: an emergency medicine review

Long

Davis

et al. 2018

Intern Emerg Med

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Toxic alcohols are a group of substances containing a hydroxyl group not meant to be ingested. They are the cause of a significant number of accidental and non-accidental exposures. Toxic alcohol poisoning can be associated with a significant degree of morbidity and mortality if not promptly recognized and treated. This review describes the clinical presentation and an approach to the recognition and management for toxic alcohol poisoning. Toxic alcohols classically refer to a group of alcohols not meant for ingestion. Methanol, ethylene glycol, and isopropyl alcohol are readily available in common hardware and household materials. Toxic alcohols are ingested for a variety of reasons including accidental exposures, intentional inebriation, homicide and suicide. The patient with an altered mental status or concerning history warrants consideration of this potentially deadly ingestion. Treatment considerations include alcohol dehydrogenase blockade and hemodialysis. Toxic alcohol poisoning can be an elusive diagnosis. This review evaluates toxic alcohol poisoning signs and symptoms and an approach to diagnosis and management.

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Acute polyradiculoneuropathy with renal failure: mind the anion gap

Cited by 7 publications

References 14 publications

Delayed ethylene glycol poisoning presenting with abdominal pain and multiple cranial and peripheral neuropathies: a case report

Delayed ethylene glycol poisoning presenting with abdominal pain and multiple cranial and peripheral neuropathies: a case report

Multiple Cranial Neuropathy with and Polyradiculoneuropathy as a Delayed Sequelae after of Ethylene Glycol Intoxication

Toxic alcohol diagnosis and management: an emergency medicine review

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