Case of the Month #2 - ethylene glycol ingestion

Published 03/02/2022

What is the management of ethylene glycol ingestion?

  • Consult TOXBASE for detailed management 
  • ABCDE assessment 
  • Consider gastric aspiration/lavage if within 1 hour of life-threatening dose and the airway is protected 
  • Antidotes: fomepizole or ethanol if there is a delay in sourcing fomepizole (these minimise further metabolism of ethylene glycol): TOXBASE recommends administration if suspected >10g ingestion within the last 12 hours or if osmolal gap >10mOsm/kg or high anion gap metabolic acidosis with no other likely cause; continue the antidotes until plasma ethylene glycol concentration <50 mg/L (<0.8 mmol/L) 
  • Metabolic acidosis: consider sodium bicarbonate if persisting acidosis despite correction of any hypoxia and optimal fluid balance 
  • Renal replacement therapy should be considered if there is severe metabolic acidosis, renal failure, worsening clinical picture despite optimal supportive management or severe electrolyte disturbance; haemodialysis is much more effective than haemofiltration for the clearance of ethylene glycol and its metabolites 
  • Other supportive management including magnesium replacement if low, however not replacing calcium if hypocalcaemia unless QT interval > 500ms or there are persistent convulsions (because of the risk of worsening calcium oxalate crystal formation when calcium is administered)