Ethylene Glycol Elimination Kinetics and Outcomes in Patients Managed Without Hemodialysis

Levine, M.D. Norman; Curry, Steven C.; Ruha, Anne‐Michelle; Pizon, Anthony F.; Boyer, Edward W.; Burns, Jarrett M.; Bikin, Dale S.; Gerkin, Richard

doi:10.1016/j.annemergmed.2011.12.001

Cited by 16 publications

(4 citation statements)

References 18 publications

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“…3 However, the overall contribution of the kidneys remains relatively small compared with HD: the renal clearance of EG is 30 ml/min, compared with as high as 250 ml/min from HD, so the presence or absence of acute kidney injury will only have a very modest impact on the EG T 1/2 during HD. 9,[13][14][15][16][17] This was shown in our study, as the elimination EG T 1/2 of patients with acute kidney injury was only 11 minutes longer, a nonsignificant statistical or clinical difference. Similar to methanol's elimination T 1/2 , the EG T 1/2 during HD was shorter in women.…”

Section: Discussionmentioning

confidence: 55%

“…Many authors consider HD to be unnecessary in the absence of metabolic acidosis and renal failure, even if EG concentrations are very elevated. [10][11][12][13] However, a high anion gap metabolic acidosis is reflective of accumulation of EG metabolites. Furthermore, once alcohol dehydrogenase inhibition is provided, kidneys remain the only means of EG elimination.…”

Section: Discussionmentioning

confidence: 99%

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Prediction and validation of the duration of hemodialysis sessions for the treatment of acute ethylene glycol poisoning

Iliuta

Lachance

Ghannoum

et al. 2017

Kidney International

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The duration of hemodialysis (HD) sessions for the treatment of acute ethylene glycol poisoning is dependent on concentration, the operational parameters used during HD, and the presence and severity of metabolic acidosis. Ethylene glycol assays are not readily available, potentially leading to undue extension or premature termination of HD. We report a prediction model for the duration of high-efficiency HD sessions based retrospectively on a cohort study of 26 cases of acute ethylene glycol poisoning in 24 individuals treated by alcohol dehydrogenase competitive inhibitors, cofactors and HD. Two patients required HD for more than 14 days, and two died. In 19 cases, the mean ethylene glycol elimination half-life during high-efficiency HD was 165 minutes (95% confidence interval of 151-180 minutes). In a training set of 12 patients with acute ethylene glycol poisoning, using the 90th percentile half-life (195 minutes) and a target ethylene glycol concentration of 2 mmol/l (12.4 mg/dl) allowed all cases to reach a safe ethylene glycol under 3 mmol/l (18.6 mg/dl). The prediction model was then validated in a set of seven acute ethylene glycol poisonings. Thus, the HD session time in hours can be estimated using 4.7 x (Ln [the initial ethylene glycol concentration (mmol/l)/2]), provided that metabolic acidosis is corrected.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Prediction and validation of the duration of hemodialysis sessions for the treatment of acute ethylene glycol poisoning

Iliuta

Lachance

Ghannoum

et al. 2017

Kidney International

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“…12 Fomepizole without extracorporeal removal was used in 13 patients with ethylene glycol or methanol concentrations exceeding 500 mg/L and there was complete recovery in all cases. Recent evidence suggests that fomepizole may obviate the need for haemodialysis in selected cases, 13 but the cost-effectiveness of this treatment strategy is controversial depending on the local cost of intensive care and dialysis over a short period compared to a more prolonged course of fomepizole. 14 In the UK, joint College of Emergency Medicine/NPIS guidelines on antidote stocking in acute hospitals recommend fomepizole as the antidote of choice for toxic alcohol and glycol poisoning, but an audit conducted in parallel to this study in 2010 showed that only around 20% of acute hospitals in the UK stocked this antidote.…”

Section: Discussionmentioning

confidence: 99%

Management of poisoning with ethylene glycol and methanol in the UK: a prospective study conducted by the National Poisons Information Service (NPIS)

Thanacoody

Gilfillan

Bradberry

et al. 2015

Clinical Toxicology

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“…Levine et al described 40 patients with confirmed ethylene glycol poisoning that were managed successfully with fomepizole and without dialysis. 7 None of these patients died. Only 1 patient developed nonoliguric RI with a peak Cr of 2.1.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Death and Prolonged Renal Insufficiency in Ethylene Glycol Poisoning

Lung

Kearney

Brasiel

et al. 2013

J Intensive Care Med

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Background: We assessed the predictive value of selected factors on the outcomes of death and prolonged renal insufficiency (RI) from ethylene glycol poisoning. Methods: Retrospective, observational California Poison Control System study, over a 10-year period (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008). We compared 2 groups. The first group (D/RI) included 59 patients who died (9 patients) or had prolonged RI (50 patients). Prolonged RI was defined as kidney injury in which dialysis was required for greater than 3 days after presentation. The second group (RECOV) of 62 patients had an uncomplicated recovery. Secondarily, we evaluated the association of time to antidote (ethanol and/or fomepizole) and time to dialysis with these outcomes. Results: The D/RI group was more likely than the RECOV group to present comatose, have seizures, and require intubation. The D/RI group had a lower mean initial arterial pH of 7.03 (standard deviation [SD] 0.20), compared to 7.27 (SD 0.14) for the RECOV group. The D/RI group had a higher initial creatinine (1.7 mg/dL, SD 0.71) than that of the RECOV group (1.0 mg/dL, SD 0.33). Patients with a time to antidote greater than 6 hours had a higher odds of dying or having prolonged RI (OR 3.34, 95% CI : 1.21-9.26) Patients with a time to dialysis greater than 6 hours had a lower odds of dying or having prolonged RI (OR 0.36, 95% CI : 0.15-0.87). Conclusion: Compared to survivors with an uncomplicated recovery, patients poisoned with ethylene glycol who died or had prolonged RI were more likely to exhibit clinical signs such as coma, seizures, and acidosis. Antidote administration within 6 hours is associated with better outcomes, unlike earlier time to dialysis.

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Ethylene Glycol Elimination Kinetics and Outcomes in Patients Managed Without Hemodialysis

Cited by 16 publications

References 18 publications

Prediction and validation of the duration of hemodialysis sessions for the treatment of acute ethylene glycol poisoning

Prediction and validation of the duration of hemodialysis sessions for the treatment of acute ethylene glycol poisoning

Management of poisoning with ethylene glycol and methanol in the UK: a prospective study conducted by the National Poisons Information Service (NPIS)

Predictors of Death and Prolonged Renal Insufficiency in Ethylene Glycol Poisoning

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