Case of the Month #2 - ethylene glycol ingestion

Published 03/02/2022

How does ethylene glycol ingestion present?

There are different clinical signs depending on the quantity and timing of ingestion. This can be categorised into three separate phases (according to TOXBASE):

Phase 1 (30 minutes-12 hours since ingestion):

  • Similar to being intoxicated with ethanol 
  • Nausea, vomiting, haematemesis 
  • Decreased consciousness 
  • Nystgmus, ataxia, ophthalmoplegia 
  • Papilloedema 
  • Seizures 
  • Metabolic acidosis 

Phase 2 (12-24 hours since ingestion):

  • Tachypnoea 
  • Sinus tachycardia 
  • Hypertension 
  • Congestive cardiac failure with pulmonary oedema 

Phase 3 (24-72 hours since ingestion):

  • Flank pain/renal angle tenderness 
  • Renal failure 
  • Hypocalcaemia (because calcium binds with oxalate to form crystals) 
  • Hyperkalaemia 
  • Hypomagnesaemia 

Investigation findings

  • Ethylene glycol level (difficult to obtain due to delays in sending to reference lab) 
  • High anion gap metabolic acidosis due to glycolic acid accumulation 
  • High osmolal gap 
  • The blood gas may be normal very early in the presentation. Blood lactate may be elevated because of multi-organ dysfunction, but it may also be reported as falsely high because of cross-reactivity between lactate and ethylene glycol metabolites in the blood gas analyser. 
  • Oxalate crystals in urine