Successful therapy of paediatric ethylene glycol poisoning: a case report and annual survey by a regional poison centre

Schwerk, Nicolaus; Desel, Herbert; Schulz, Manuela; Schwerk, Christina; Kieß, Wieland; Siekmeyer, Werner

doi:10.1111/j.1651-2227.2007.00115.x

Cited by 14 publications

(10 citation statements)

References 10 publications

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“…Several pediatric cases of EG poisoning with fomepizole therapy have been reported [13,14], with similar efficacy and side effects to those in adults. Therefore, fomepizole seems to be the first choice for the treatment of EG intoxication, but it is not available in all centers [10]. Guidelines recommend hemodialysis if the EG serum level is above 500 mg/l, but the rationale for this recommendation is unclear [10].…”

Section: Ethylene Glycolmentioning

confidence: 98%

“…Therefore, fomepizole seems to be the first choice for the treatment of EG intoxication, but it is not available in all centers [10]. Guidelines recommend hemodialysis if the EG serum level is above 500 mg/l, but the rationale for this recommendation is unclear [10].…”

Section: Ethylene Glycolmentioning

confidence: 98%

“…In a retrospective study, metabolic acidosis was observed in 41% of patients after unintentional ingestion of EG, vomiting in 36%, nephrotoxicity in 10% and neurotoxicity in 9% [9]. EG poisoning is confirmed by the detection of EG in the patient's blood and by quantitative analysis of glycol in the serum, but only a few laboratories are able to perform this measurement in emergency cases [10].…”

Section: Ethylene Glycolmentioning

confidence: 98%

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Non-drug-induced nephrotoxicity

et al. 2009

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Several drugs and other compounds can induce acute and/or chronic nephrotoxicity. The goal of this study was to review clinical features of nephrotoxicity induced by 'atypical' or 'unconventional' agents, such as environmental agents (metals, minerals, animals), food agents (mushrooms, aristolochic acid, medicinal traditional herbals, dietary supplements, melamine), drugs, and other products (ethylene glycol). Nephrotoxicity varies according to local background, dependent on different food and cultural customs, as well as to differences in local fauna and flora. The incidence of such a phenomenon is not well known. Many different pathophysiological pathways are involved, and the spectrum of renal lesions is rather wide. 'Epidemic nephrotoxicity' may occur, as recently illustrated by the melamine epidemics in Chinese infants receiving powdered milk formulas; a rapid reaction to unusual increased frequency of acute kidney injury and nephrolithiasis in young children has led to a rapid analysis from international experts, with subsequent recommendations for diagnosis and care. Nephrotoxicity should be considered when there is any unexplained renal impairment, especially in children.

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Section: Ethylene Glycolmentioning

confidence: 98%

Section: Ethylene Glycolmentioning

confidence: 98%

Section: Ethylene Glycolmentioning

confidence: 98%

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Non-drug-induced nephrotoxicity

et al. 2009

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“…14 Intoxication in children (ages 0-11 years) or adolescents (11-19 years) is less frequent and can be due to accidental ingestion of this fluid or purposely given to the child by a care giver. 15,16 Diethylene glycol has been illegally used as a diluent in medications, but is also present in some brake fluids and artificial fog solutions. 17 Poisoning with diethylene glycol is rare, but most commonly is reported in children given medication in which it is illegally used as a diluent.…”

Section: History and Physical Examinationmentioning

confidence: 99%

Diagnosis of toxic alcohols: limitations of present methods

Kraut¹

2015

Clinical Toxicology

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Exposure to toxic alcohols is associated with cellular dysfunction and increased risk of death. Treatment, if initiated early, can markedly improve outcome, but present methods of diagnosis including changes in serum osmol and anion gap, and use of gas or liquid chromatography have important limitations. Development of more rapid and effective tests for detection of these intoxications is essential for optimal care of patients.

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“…Davis et al treated a patient with a plasma ethylene glycol level of 888 mg/dL (143 mmol/L)8), with the same ethanol dose. Schwerk et al treated a patient with a even higher level of ethylene glycol, 3,900 mg/dL (629 mmol/L), with the standard dose of ethanol9). The highest concentration of plasma methanol intoxication was the case reported by Martens et al10), and the patient had a plasma methanol of 921.2 mg/dL, and was again treated with the standard dose of ethanol.…”

Section: Which Is Better: Ethanol or Fomepizole?mentioning

confidence: 99%

Uncoventional Views on Certain Aspects of Toxin-Induced Metabolic Acidosis

2010

Electrolyte Blood Press

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This discussion will highlight the following 9 specific points that related to metabolic acidosis caused by various toxins. The current recommendation suggests that alcohol dehydrogenase inhibitor fomepizole is preferred to ethanol in treatment of methanol and ethylene glycol poisoning, but analysis of the enzyme kinetics indicates that ethanol is a better alternative. In the presence of a modest increase in serum osmolal gap (<30 mOsm/L), the starting dose of ethanol should be far less than the usual recommended dose. One can take advantage of the high vapor pressure of methanol in the treatment of methanol poisoning when hemodialysis is not readily available. Profuse sweating with increased water ingestion can be highly effective in reducing methanol levels. Impaired production of ammonia by the proximal tubule of the kidney plays a major role in the development of metabolic acidosis in pyroglutamic acidosis. Glycine, not oxalate, is the main final end product of ethylene glycol metabolism. Metabolism of ethylene glycol to oxalate, albeit important clinically, represents less than 1% of ethylene glycol disposal. Urine osmolal gap would be useful in the diagnosis of ethylene glycol poisoning, but not in methanol poisoning. Hemodialysis is important in the treatment of methanol poisoning and ethylene glycol poisoning with renal impairment, with or without fomepizole or ethanol treatment. Severe leucocytosis is a highly sensitive indicator of ethylene glycol poisoning. Uncoupling of oxidative phosphorylation by salicylate can explain most of the manifestations of salicylate poisoning.

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Successful therapy of paediatric ethylene glycol poisoning: a case report and annual survey by a regional poison centre

Abstract: Ethylene glycol poisoning is rare in the paediatric age group in our series of glycol poisonings. One should keep in mind, that early diagnosis and treatment due to clinical signs is important and haemodialysis usually is not necessary.

Cited by 14 publications

References 10 publications

Non-drug-induced nephrotoxicity

Non-drug-induced nephrotoxicity

Diagnosis of toxic alcohols: limitations of present methods

Uncoventional Views on Certain Aspects of Toxin-Induced Metabolic Acidosis

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