Alcohol: Ethylene glycol

• ethanol

• fomepizole

• haemodialysis

treatment options for ethylene glycol poisoning (3)

>1

Ingestion of ___ mL/kg of 100% ethylene glycol is potentially lethal

Dermal & Inhalation

____ and ____ exposure does not lead to ethylene glycol intoxication.

• glycolic & oxalic

• high anion-gap metabolic acidosis (HAGMA)

In ethylene glycol intoxication, toxic effects are due to accumulation of _____ and _____ acid metabolites, resulting in a severe, progressive

• oliguric renal

• calcium oxalate

• glycolic

Acute _____ failure occurs secondary to _____ crystal deposition in renal tubules and the nephrotoxic effects of ____ acid.

• rapidly

• 2

Ethylene glycol is ____ absorbed following ingestion and peak concentrations occur within ___ hours.

• aldehyde dehydrogenase (ALDH)

• glycoaldehyde & glycolic

• glyoxylic & oxalic

Ethylene glycol is metabolised sequentially by alcohol dehydrogenase (ADH) and ______ to ______ and ______ acid, which in turn is converted to ______ acid and _____ acid

• 3-9

• 20

elimination half-life of ethylene glycol is ____ hours but increases to ____ hours in the presence of ethanol or fomepizole

• 2

• 4-12

Initial clinical features develop within the first ___ hours and Progressively severe features develop over the ____ hours

renal failure

Flank pain and oliguria indicate acute ______

• cerebral oedema

• ischaemic encephalopathy

Persistent coma or neurocognitive deficits may result from ______ or ______

osmolar gap

Ingestion of ethylene glycol results in initial elevation of the _______

• pH

• venous bicarbonate

• acidosis

Progressive decrease in the _____ and _____ concentration indicate worsening ______

falsely elevated serum lactate

useful early indicator of ethylene glycol poisoning

calcium oxalate crystals

Presence of ______ in the urine is pathognomonic of ethylene glycol intoxication

• apnoea

• cardiac arrest

In patients maintaining effective ventilation, intubation is to be avoided as even a brief period of _____ during standard rapid sequence intubation can lead to _____

Sodium bicarbonate

______ is an immediate priority in patients with severe metabolic acidosis awaiting haemodialysis

• IV

• 1-2

Administer ____ sodium bicarbonate boluses ____ mmol/kg guided by serial blood gases and clinical response

• hyperventilation

• bolus IV sodium bicarbonate

Maintain _____ and consider further _____ to prevent worsening acidaemia pending haemodialysis.

• pyridoxine 50 mg IV 6 hourly

• thiamine 100-300 mg IV or PO 6 hourly

indicated to enhance metabolism of glyoxylic acid (2)

Haemodialysis

definitive management of ethylene glycol poisoning, as it removes ethylene glycol and corrects acidosis

Lactate-free dialysate with added bicarbonate

indicated in the setting of significant acidaemia

4-12

Acid-base status and electrolytes are repeated every ____ hours following cessation of haemodialysis to confirm that further dialysis is not required.

ethanol & fomepizole

used in the treatment of suspected or confirmed ethylene glycol poisoning

• 22 (100; 0.1

Ethanol at a serum concentration of ___ mmol/L ( ___ mg/dL; ___%) competitively inhibits ADH so that ethylene glycol is not metabolised.

fomepizole

preferred antidotal therapy for paediatric poisoning with ethylene glycol

Serum bicarbonate levels

• provide a surrogate marker of glycolic and oxalic acid production

• Anion gap acidosis

• creatinine

_____ with elevated lactate (± elevated osmolar gap) associated with hypocalcaemia and rising _____ is pathognomonic of ethylene glycol intoxication.