Ethylene Glycol Poisoning

Ethylene Glycol poisoning • Found in: detergent, antifreeze, polish • The toxic metabolite Glycolic acid is responsible for the metabolic acidosis with anion gap, and osmolar gap • S/S depend on when they present and at which stage: o Stage I (30min-12hr) CNS→ with hallucination, coma, Sz, tetany o II (12-24hr) Cardioresp→ HTN, tachycardia, pul edema o III (24-72hr) Renal→ flank pain, Ca oxalate in the urine • Management: o ABC o Lab: CBC-D, Lytes, BUN, creat, EG level, ABG, Osmolality, CXR, ECG o Monitors: ECG, art-line, pulse oxi, Foley cath o ECG→ ↑QT, Lytes→ ↓Ca o Gastric lavage o Depend on the serum level of EG whether to give EtOH or not or to start HD

o If < 10mg/dl only watch, 20-50 → start EtOH loading then infusion loading 10mg/kg over 30-60min then 1.5mg/kg/hr until EtOH level 100200, or EG=0 o If >50 start HD, or if Pt is hemodynamic unstable, or refractory acidosis o Consider Bicarb, Ca, and thiamine