ethylene glycol toxicity

This patient has typical findings of ethylene glycol toxicity, including central nervous system depression, an increased anion gap metabolic acidosis, and an increased plasma osmolar gap.

Because laboratory confirmation of ethylene glycol intoxication may take days, empiric therapy with fomepizole and aggressive fluid resuscitation with crystalloids (250-500 mL/h intravenous initially) should be instituted in all cases to increase kidney clearance of the toxin and to limit deposition of oxalate in the renal cortex. Hemodialysis to clear the alcohol and toxic metabolites should be instituted in the context of any organ-specific toxicity (central nervous system depression, acute kidney injury, systemic collapse), severe acidemia, or very large ingestions.

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