Predictors of Death and Prolonged Renal Insufficiency in Ethylene Glycol Poisoning

Abstract

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.

Anion gap‐opening metabolic acidosis and urinary findings in the early diagnosis of ethylene glycol poisoning: A case report

“…Administration of antidote >6 h after arrival at the hospital has been associated with death and renal failure. 16 In this case, early diagnosis and recognition, and collaboration with the laboratory, pharmaceutical department, pharmaceutical company, and the police led to rapid intervention with fomepizole after the initial treatment with 10% ethanol infusion. The exact onset time was unknown, and it was unclear whether the treatment should be started within 6 hours; nonetheless, it was started immediately.…”

Case Files of the University of California, San Francisco Medical Toxicology Fellowship: Seizures and a Persistent Anion Gap Metabolic Acidosis

“…Alcohols such as methanol and ethylene glycol may rarely present with seizure [6,7]. However, our patient has no clinical history of access to these alcohols, had no evidence of an osmolal gap, and has not developed worsening severe acidosis.…”

Sequential episodes of ethylene glycol poisoning in the same person

“…In a retrospective study, Lung et al observed that patients presenting with comatose or seizures were those who had renal insufficiency. When compared with survivors who recovered without complications, they initially had a lower mean arterial pH (7.03 vs 7.27) and higher initial serum creatinine (1.7 vs 1.1) 13. According to Coulter et al, higher OG and anion gap have also been associated with higher risk of death 14…”