Ethylene glycol poisoning: a rare but life-threatening cause of metabolic acidosis--a single-centre experience

Abstract

Background. Intoxication with ethylene glycol happen all around the world and without rapid recognition and early treatment, mortality from this is high. Methods. In our study, we retrospectively analysed six cases of ethylene glycol intoxication in our department. We measured ethylene glycol or glycolate levels, lactate levels and calculated the osmolal and anion gap. Results. Data from six patients admitted to the nephrology department between 1999 and 2011 with ethylene glycol poisoning are reported. All patients were men. The mean pH on admission was 7.15 ± 0.20 and the anion and osmolal gap were elevated in five of six patients. Four patients had an acute kidney injury and one patient had an acute-on-chronic kidney injury. All patients survived and after being discharged, two patients required chronic intermittent haemodialysis. Interestingly, at the time of admission, all patients had elevated lactate levels but there was no linear regression between toxic levels and lactate levels and no linear correlation was found between initial lactate levels and anion gap and osmolal gap. Conclusions. The initial diagnosis of ethylene glycol poisoning is difficult and poisoning with ethylene glycol is rare but life threatening and needs rapid recognition and early treatment. Therefore, intoxication with ethylene glycol should not be misdiagnosed as lactic acidosis in patients with metabolic acidosis and elevated lactate levels.

Treatment of Ethylene Glycol Poisoning with Oral Ethyl Alcohol

“…Then, there is a cardiorespiratory phase (12 to 24 hours) after intoxication that appears with the onset of tachypnea and hypotension or congestive heart failure. Finally, 24 hours after ingestion, the patients develop flank pain and oxalate crystalluria, often followed by oliguria and acute kidney injury [5]. The toxic and lethal dose of 100% ethylene glycol is documented as approximately 0.2 ml/kg and 1.4 ml/kg, respectively [6].…”

“…Acidosis was corrected, urine output resumed, and she was discharged with no residual complications. Treatment with hemodialysis is recommended in the setting of known ethylene glycol ingestion if either there is a high anion gap metabolic acidosis, regardless of drug level, or there is evidence of end-organ damage [4, 5]. Mortality in ethylene glycol poisoning is around 27% [17].…”

Ethylene Glycol Toxicity in the Setting of Recurrent Ingestion: A Case Report and Literature Review

“…EG toxicity characteristically presents as a severe metabolic acidosis with a high anion gap (27.8 +/- 12.4 mEq/L), elevated osmolal gap (33.3 +/- 5.99 mOsm/L) and large mean base deficit (18.6 +/- 10.9 mEq/L) [15]. A significantly elevated osmolal gap is highly specific but poorly sensitive for EG poisoning [16-17].…”

Острое Отравление Этиленгликолем В Клинической Практике

“…Клінічні прояви отруєння ЕГ характеризуються розвитком трьох стадій: перша -пригнічення центральної нервової системи (ЦНС) (наркотична фаза); друга -токсичне ураження серця, легень; третя -токсичне ураження нирок, печінки [4,6,9,22,23]. Проте стадії і симптоми в конкретного пацієнта можуть не мати чіткого поділу і нашаровуються одна на одну.…”

“…Афінність АДГ до даного антидоту багаторазово перевищує спорідненість ферменту до ЕГ. Застосування проводиться за такою схемою: внутрішньовенно в дозі 15 мг/кг, у подальшому по 10 мг/кг через кожні 12 годин протягом 2 діб, дозу після 2-ї доби збільшують до 15 мг/кг у зв'язку з активацією метаболізму препарату ферментними системами [6,13,21,23]. Застосування антидотів поєднується з введенням піридоксину і тіаміну, які допомагають перетворювати токсичні метаболіти ЕГ у нетоксичні [19].…”