Ethylene Glycol Ingestion
Posted: Wednesday, September 13th, 2023 | Updated: Wednesday, September 13th, 2023
Posted: Wednesday, September 13th, 2023 | Updated: Wednesday, September 13th, 2023
General Information:
Ethylene glycol or antifreeze ingestion is serious and can lead to acute kidney injury followed by renal failure and eventually death without prompt treatment. Ethylene glycol is rapidly absorbed by the body once ingested, hence, the induction of emesis may not be helpful at times. CNS signs, depression, ataxia, seizures, hypersalivation, nausea, vomiting, and gastrointestinal upset may be seen within 30 minutes of ingestion. Cardiovascular signs may be seen from 4 to 6 hours post ingestion. Renal changes or azotemia may be witnessed anywhere from 24 to 36 hours. Calcium oxalate crystals may be identified in the urine sediment exam within 4 hours of ingestion. An elevated anion gap is usually seen on bloodwork. Patients should be monitored for polyuria, polydipsia, oliguria, anuria, hypocalcemia, and metabolic acidosis. If any signs appear, treatment with the anti-dote, 4-MP, Fomepizole, or Methylpyrazole 5% may be started along with fluid diuresis. 4-MP is usually dosed at the time of presentation with or without clinical signs, at the 12 hour mark, the 24 hour mark, and finally at the 36 hour mark. Treatment may be initiated even if the patient was only suspected to have ingested ethylene glycol. The medication has been given over a 30 minute period without any problems or reactions. The antidote, 4-MP, helps to prevent the toxin from being metabolized by the liver. Therefore, this prevents calcium oxalate crystals from developing and gathering in the kidneys. Renal values and urine output should be regularly monitored during hospitalization. Hospitalization is usually recommended for 36 to 72 hours. Ethylene glycol may be detected in the serum at certain labs specializing in toxicology.
Ethylene glycol or antifreeze ingestion is serious and can lead to acute kidney injury followed by renal failure and eventually death without prompt treatment. Ethylene glycol is rapidly absorbed by the body once ingested, hence, the induction of emesis may not be helpful at times. CNS signs, depression, ataxia, seizures, hypersalivation, nausea, vomiting, and gastrointestinal upset may be seen within 30 minutes of ingestion. Cardiovascular signs may be seen from 4 to 6 hours post ingestion. Renal changes or azotemia may be witnessed anywhere from 24 to 36 hours. Calcium oxalate crystals may be identified in the urine sediment exam within 4 hours of ingestion. An elevated anion gap is usually seen on bloodwork. Patients should be monitored for polyuria, polydipsia, oliguria, anuria, hypocalcemia, and metabolic acidosis. If any signs appear, treatment with the anti-dote, 4-MP, Fomepizole, or Methylpyrazole 5% may be started along with fluid diuresis. 4-MP is usually dosed at the time of presentation with or without clinical signs, at the 12 hour mark, the 24 hour mark, and finally at the 36 hour mark. Treatment may be initiated even if the patient was only suspected to have ingested ethylene glycol. The medication has been given over a 30 minute period without any problems or reactions. The antidote, 4-MP, helps to prevent the toxin from being metabolized by the liver. Therefore, this prevents calcium oxalate crystals from developing and gathering in the kidneys. Renal values and urine output should be regularly monitored during hospitalization. Hospitalization is usually recommended for 36 to 72 hours. Ethylene glycol may be detected in the serum at certain labs specializing in toxicology.