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ethylene glycol poisoning treatment guidelines

January 1st,
2021

Ethylene glycol toxicity presenting with non-anion gap metabolic acidosis. Early in the intoxication, the toxin is present as the parent compound, ethylene glycol. Timely treatment is effective and consists of supportive A report of accidental ethylene glycol ingestion in 2 siblings. 1999; 37(5):537-60. [Full Text]. Treatment Guidelines: If ethylene glycol or methanol poisoning is left untreated, the natural progression of the poisoning leads to accumulation of toxic metabolites, including glycolic and oxalic acids (ethylene glycol intoxication) and formic acid (methanol intoxication). [Guideline] Barceloux DG, Krenzelok EP, Olson K, Watson W. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. Administer crystalloids at 250-500 mL/h IV initially to enhance renal clearance of the toxin and to limit deposition of oxalates in the renal cortices. District, Hospital, ITU, Ward . [14] Fomepizole is administered with a loading dose and twice-daily intravenous dosing. 37(5):537-60. N Engl J Med 1988;319:97–110. [Medline]. checking out the following Internet Web sites: Second, the patient has a definite history of recent ethylene glycol ingestion (especially if the osmolal gap is 10 mOsm/L or more, though patients with potentially toxic ethylene glycol ingestions may have an apparently normal osmolar gap; see Workup/Laboratory Studies). 2018 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 36th Annual Report. 2008. Breath or serum ethanol level – as part of the risk assessment, ethanol delays the clinical effects of ethylene glycol and also to calculate how much ethanol will be required as a temporary antidote. March 2010. Any patients who are ill and acidotic or who present to centers where ethanol is used instead of fomepizole should be treated in an intensive care unit (ICU) or other setting with cardiac monitoring and close nursing care. Gummin DD, Mowry JB, Spyker DA, Brooks DE, Beuhler MC, Rivers LJ, et al. December 2010. [Full Text]. Treatment with fomepizole without hemodialysis in massive ethylene glycol ingestion has been rarely reported in the literature; however, published literature and practice guidelines recommend considering dialysis for ethylene glycol levels >50 mg/dL. American Journal of Kidney Diseases. Note: Javascript is disabled or is not supported by your browser. Ingestion of ethylene glycol produces CNS depression [Medline]. [16] : Some clinicians have suggested that effective blockade of alcohol dehydrogenase may permit the treatment of ethylene glycol intoxication without dialysis. Buchanan JA, Alhelail M, Cetaruk EW, Schaeffer TH, Palmer RB, Kulig K, et al. Revision 1 TRIM: T20/77591 Date: October 2020 Page 1 of 2 ... New Drugs . 2013 Dec 26. Toxic Alcohol Ingestions: Clinical Features, Diagnosis, and Management. 1990 Jun. Courtesy of John D Schaldenbrand, MD, Department of Pathology, St Joseph Mercy Health System, Ann Arbor, MI. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. send him or her a record of your emergency department visit. Considerations in emergency department (ED) care include the following: Many patients with ethylene glycol ingestions are extremely obtunded and are at high risk of aspiration; endotracheal intubation may need to be considered. Place symptomatic patients in a monitored setting. 1994 Mar-Apr. Pyridoxine and thiamine are cofactors in ethylene glycol metabolism that promote production of nontoxic metabolites, and are safe adjuncts with no significant disadvantages.They may be administered parenterally. For this reason, some items on this page will be unavailable. Hemodialysis is used to treat metabolic acidosis or to prevent renal insufficiency. 2010 Jun. care, hemodialysis, and administration of a specific [Full Text]. If started before onset of acidosis, fomepizole may be used as the sole treatment for ethylene glycol ingestion in some cases. The patient's actual drinking habits determine the appropriate dose. The purpose of the present case report was to demonstrate 4-MP efficiency in EG poisoning in a 4-year-old child. the patient is not treated, ethylene glycol's metabolites Acad Pathol. Ad Hoc Committee. A constant rate infusion (CRI) of ethanol was also started and administered via the IV catheter. We studied the efficacy of fomepizole, a new inhibitor of alcohol dehydrogenase, in the treatment of ethylene glycol poisoning. [Medline]. Baud FJ, Galliot M, Astier A, et al. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvODE0NzAxLXRyZWF0bWVudA==. John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals Ascertain as much specific information regarding the identity of the ingested substance as possible. Ghannoum M, Hoffman RS, Mowry JB, Lavergne V. Trends in toxic alcohol exposures in the United States from 2000 to 2013: a focus on the use of antidotes and extracorporeal treatments. number of your primary care physician so that the ED can Traditional dialysis indications include the following 6(2):131-4. https://www.atsdr.cdc.gov/mmg/mmg.asp?id=82&tid=21, American College of Occupational and Environmental Medicine, American College of Physicians-American Society of Internal Medicine, American Society of Health-System Pharmacists. Corley RA, McMartin KE. Share cases and questions with Physicians on Medscape consult. 2009 Jan. 55(1):46-9. May 2005. Toxicol Sci. [Guideline] Barceloux DG, Krenzelok EP, Olson K, Watson W. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. In patients exposed to ethylene glycol, 100mg thiamine and 100mg pyridoxine can be administered IV daily to stimulate the conversion of glycolic acid and glyoxylic acid to non-toxic alpha-hydroxy-beta-ketoadipate and glycine, respectively. Third, a history or suspicion of ethylene glycol intoxication and the presence of at least two of the following antidote. Administration of either intravenous ethanol or fomepizole, both of which competitively inhibit ethylene glycol metabolism by alcohol dehydrogenase and can prevent the production and accumulation of the toxic metabolites, can be used as an antidote. Clin Toxicol (Phila). 2017 Jun. The American Academy of Clinical Toxicology recommends fomepizole as the preferred treatment in such cases. J Toxicol Clin Toxicol. Ethylene Glycol, Methanol, and Isopropyl Alcohol Intoxication. N Engl J Med. The telephone number for certified poison centers anywhere in the United States and Puerto Rico is 1-800-222-1222. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. Treatment of ethylene glycol poisoning with intravenous 4-methylpyrazole. June 2009. Diseases & Conditions, 2002 [ncbi.nlm.nih.gov] Treatment Current practice guidelines for initiating treatment of ethylene glycol poisoning have been published by the American Academy of Clinical Toxicology (AACT) 4 and are listed in Table 3. which may be accompanied by nausea, vomiting, and abdominal 13 (2):153-157. J … Significant inhalation exposure does not occur at room temperature, but respiratory tract irritation is possible when the liquid is heated, agitated, or sprayed. Obtain intravenous access and administer crystalloid infusions. [Full Text]. [Guideline] Barceloux DG, Krenzelok EP, Olson K, Watson W. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. J Med Toxicol. Massive ethylene glycol ingestion treated with fomepizole alone-a viable therapeutic option. Baud FJ, Galliot M, Astier A, et al. It is widely available as automotive antifreeze; in that application, it is often mixe… Educational Case: Ethylene Glycol Poisoning. A regional poison control center (1-800-222-1222) should be contacted for indications and dosing. John G Benitez, MD, MPH Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center [Medline]. mucous membranes and is not absorbed well through the skin If you log out, you will be required to enter your username and password the next time you visit. Obtain a ethylene glycol serum concentration if you have access to this at your institution or locally. An integrated perspective on the developmental toxicity of ethylene glycol. Arch Dis Child. Traditionally, gastric lavage or nasogastric aspiration of gastric contents are the most common methods employed in ethylene glycol poisoning. Ethylene glycol is a clear, odorless, slightly viscous liquid with a sweet taste. There are three main goals associated with the treatment of ethylene glycol toxicity: 1) Decrease the amount of ethylene glycol that is absorbed, 2) Flush the unabsorbed ethylene glycol out of the animal’s system, and 3) Prevent absorbed ethylene glycol from being metabolized (Grauer). Persons exposed to ethylene glycol do not pose a significant risk of secondary contamination to response personnel outside the Hot Zone. Weigh the benefits, risks, and costs of each therapeutic intervention at the treating institution. Administer bicarbonate to correct severe acidosis (pH level ≤7.2); this of course should be done in conjunction with addressing the underlying cause of the acidosis. 814701-overview 888-232-6348 (TTY) The availability of timely results of laboratory tests can be a problem. Barceloux DG, Krenzelok EP, Olson K, Watson W. J Toxicol Clin Toxicol. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. Ethylene glycol is a widely used chemical that is capable of causing significant injury if ingested. Sage W Wiener, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, Society for Academic Emergency MedicineDisclosure: Nothing to disclose. Fomepizole received US Food and Drug Administration (FDA) approval for use in ethylene glycol intoxication in December 1997, and it appears to have largely supplanted ethanol as the antidote of choice in toxic alcohol exposures in the US. Pathology 1995; 27:273. Early and Late Presentations of Ethylene Glycol Poisoning. A review of 121 ethylene glycol poisoning cases found that patients who did not receive an antidote (ethanol and/or fomepizole) until more than 6 hours had passed had higher odds of dying or having prolonged renal insufficiency (odds ratio 3.34). An electrocardiogram may be useful to detect arrhythmias that may result from hypocalcemia. [Medline]. 48:979-1178. Methylpyrazole for Toxic Alcohols Study Group. An IV catheter was placed in Max’s left front leg so that IV fluids could be administered to flush out any remaining ethylene glycol. 325574-overview Daniel C Keyes, MD, MPH Associate Chair, Academic Affairs, Department of Emergency Medicine, St Joseph Mercy Hospital; Clinical Faculty, Emergency Medicine Residency, University of Michigan Medical School; Clinical Associate Professor, Department of Surgery, Division of Emergency Medicine and Toxicology, University of Texas Southwestern School of Medicine [Medline]. can cause acidosis, hyperventilation, and renal failure Dermal absorption is negligible and does not contribute significantly to systemic toxicity. 19(6):663-7. not pose significant risks of secondary contamination to This is performed with either fomepizole (4-MP) or … Foley catheterization may be considered for patients with altered mental status, to monitor urinary output and to allow serial examination of urine for crystals or fluorescence. Persons exposed to ethylene glycol liquid or vapor do (See supplemental page for metabolic pathway figures for ethylene glycol and methanol). Patients exposed to ethylene glycol liquid or vapor pose If ethylene glycol poisoning is suspected, begin antidotal therapy empirically while awaiting confirmation. Ad Hoc Committee. Initial emergency department treatment includes infusion of crystalloids to enhance renal clearance of the toxic metabolites. Eventually, oxalate is deposited in the kidney and elsewhere; renal insufficiency may ensue. cramps. When administering ethanol, determine glucose levels by fingerstick collection at regular intervals and confirm with laboratory analysis, as hypoglycemia is occasionally associated with ethanol therapy. In the United States, contemporary treatment of this poisoning is most commonly done with fomepizole alone. Fomepizole is used to treat and prevent toxicity from ethylene glycol poisoning. The main drawback of fomepizole is the cost, which can total thousands of dollars. rescuers. -Consider concomitant dialysis for renal failure, metabolic acidosis, or ethylene glycol/methanol concentrations of 50 mg/dL or higher.-Discontinue this drug when ethylene glycol/methanol concentrations are undetectable, or below 20 mg/dL and patient is asymptomatic with normal pH. Fomepizole for the treatment of ethylene glycol poisoning. Daniel C Keyes, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, American College of Physicians-American Society of Internal MedicineDisclosure: Nothing to disclose. Clin J Am Soc Nephrol. 2019 Dec. 57 (12):1220-1413. Urine fluorescence using a Wood's lamp to detect the antifreeze additive sodium fluorescein: a qualitative adjunctive test in suspected ethylene glycol ingestions. Measure levels of electrolytes, calcium, and magnesium, especially in patients with alcoholism because alcohol is a cofactor in oxalate metabolism. [Medline]. Ingestion is the most important exposure route. Fomepizole for the treatment of ethylene glycol poisoning. Clin Toxicol (Phila). acidosis and damage to the brain, heart, and kidneys. antidote such as ethanol or 4-methylpyrazole (fomepizole). Divakar Jammalamadaka and Sina Raissi. Infuse the loading dose and the maintenance dose over the first hour of therapy. Rapid recognition and early treatment, including alcohol dehydrogenase (ADH) inhibition, are crucial. [Medline]. [Full Text]. If 2020 Jan-Dec. 7:2374289519900330. Avoid giving calcium to patients with ethylene glycol intoxication, as this may exacerbate the precipitation of calcium oxalate in tissues. Ethylene glycol is a very useful industrial compound because of its low freezing point and high boiling point. However, because of the cost of fomepizole and the safety of hemodialysis, the threshold for this approach should be carefully considered on the basis of the clinical setting. Reprod Toxicol. [13], Fomepizole (Antizol) is a convenient antidotal therapy for treatment of ethylene glycol or methanol intoxication. 8(2):99-113. Although ethanol is the traditional antidote for ethylene glycol poisoning, it has not been studied prospectively. Methanol and ethylene glycol poisonings cause scores of fatal intoxications annually, and even relatively small ingestions of these alcohols can produce significant toxicity. The American Journal of the Medical Sciences. The most important initial treatment for ethylene glycol poisoning is stabilizing the person. Delays may result in renal failure or other severe complications. Treatment for ethylene glycol poisoning typically includes basic supportive care, alcohol dehydrogenase inhibition, and hemodialysis. Soghoian S, Sinert R, Wiener SW, Hoffman RS. Ann Emerg Med. All material on this website is protected by copyright, Copyright © 1994-2020 by WebMD LLC. Treatment Guidelines: If ethylene glycol or methanol poisoning is left untreated, the natural progression of the poisoning leads to accumulation of toxic metabolites, including glycolic and oxalic acids (ethylene glycol intoxication) and formic acid (methanol intoxication). You or your physician can get more information on the It is combustible and has a low vapor pressure. ATSDR. 2002 Consulting a nephrologist early in the intoxication is prudent to facilitate the timely initiation of dialysis to these patients. Emergency medical services should do the following: Rapidly evaluate patients who present with signs, symptoms, or history of toxic alcohol ingestion; determine serum osmolal gap. Guidelines on the medical management of ethylene glycol poisoning are available from the Agency for Toxic Substances and Disease Registry. [Guideline] Barceloux DG, Krenzelok EP, Olson K, Watson W. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. ___________;__________. It is highly recommended to include the regional poison center (or a toxicologist) in the management of these patients. June 2009. Winter ML, Ellis MD, Snodgrass WR. John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System PharmacistsDisclosure: Nothing to disclose. Fomepizole (4-methylpyrazole, 4-MP, Antizol™) is a potent inhibitor of alcohol dehydrogenase that was approved recently by the US Food and Drug Administration (FDA) for the treatment of ethylene glycol poisoning. Sage W Wiener, MD Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center; Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital Center These clinics specialize in 38(1):49-54. Usual Adult Dose for Ethylene Glycol Poisoning Ethylene glycol is a CNS depressant, similar to ethanol. Semin Dial. acidosis, cerebral edema, cardiovascular collapse, acute The latter is usually administered intravenously but may be administered orally in remote settings where emergency hospital care is not immediately available. J Intensive Care Med. Ann Emerg Med. 3:208-225. Ingestion of ethylene glycol causes CNS depression. The usefulness of gastric lavage has, however, been questioned, and it is now no longer used routinely in poisoning situations. In one case report, 27(4):395-401. ATSDR can also tell you the location of occupational and environmental health clinics. recognizing, evaluating, and treating illnesses resulting from exposure to hazardous substances. This is performed with either fomepizole (4-MP) or ethyl alcohol. Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT Associate Clinical Professor, Department of Surgery/Emergency Medicine and Toxicology, University of Texas School of Medicine at San Antonio; Medical and Managing Director, South Texas Poison Center [Medline]. 340 (11):832-8. [1]. [Medline]. Basic Clin Pharmacol Toxicol. Epidemics of acute renal failure in children (diethylene glycol toxicity). [Full Text]. Monitor cardiac function and determine blood dextrose level. Once any of these manifestations occurs, antidotal therapy alone (used to block alcohol dehydrogenase with ethanol or fomepizole) is insufficient to treat the poisoning. renal failure, and possibly death. 53:1091-1097. . J Med Toxicol. MEDICAL TREATMENT: For large ingestions of ethylene glycol, attempt to aspirate stomach (gastric) contents using a nasogastric tube, if it can be done within the first 30 to 60 minutes. Treatment of ethylene glycol poisoning with intravenous 4-methylpyrazole. Fomepizole is equally efficacious for the treatment of methanol intoxication but does not cause any alteration in mental status, hypoglycemia, or respiratory depression. Metabolites of ethylene glycol produce severe metabolic N Engl J Med 1988; 319:97. As ethylene glycol is rapidly absorbed, gastric decontamination is unlikely to be of benefit unless it is performed within 60 minutes of ingestion. [Full Text]. October 21, 2014; Accessed: May 29, 2020. Medical Management Guidelines for Ethylene Glycol. 339:276-281. Overly aggressive ethanol administration has reportedly caused cases of apnea that required intubation and mechanical ventilation, so serum ethanol concentrations must be checked regularly and the infusion rate adjusted to prevent over- or undertreatment. Its metabolites are toxic and cause profound metabolic The prehospital (EMS) personnel often can provide important details regarding the identity of the chemical(s) involved and the clinical characteristics of the patient. Timely treatment is effective and consists of supportive Fomepizole is a comparatively newer agent with specific indication for ethylene glycol poisoning and has been approved by the US Food and Drug Administration [ 1. Treatment can include administration of ethanol or fomepizole, both inhibitors of the enzyme alcohol dehydrogenase to prevent formation of its metabolites, and hemodialysis to remove methanol and formate. E… Treatment of patients with suspected ethylene glycol intoxication has traditionally been indicated in any of the following three circumstances. Activated charcoal and nasogastric lavage have no role in toxic alcohol poisoning; typically the alcohols will be absorbed too quickly for either of these modalities to have any efficacy. Calcium oxalate stones in the urine aren't highly specific for ethylene glycol intoxication, so their presence isn't necessarily an indication for hemodialysis. Jeffrey Kraut and Ira Kurtz. A loading dose of ethanol is administered based on body weight, followed by infusion to maintain a serum level of approximately 100 mg/dL. Carefully calculate the loading dose and administration of ethanol antidote to prevent excessive administration. Abid A Kagalwalla, MD Resident Physician, Department of Emergency Medicine, St Joseph Mercy Hospital, University of Michigan Health System, Abid A Kagalwalla, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine. [Medline]. inadequate or delayed. Can Fam Physician. Tests under study to detect methanol or its metabolite formate might facilitate the diagnosis of this poisoning. Procedures, 2002 Obtain intravenous access and laboratory specimens. [Medline]. American Journal of Kidney Diseases. Oxalate crystals. Hodgman M, Marraffa JM, Wojcik S, Grant W. Serum Calcium Concentration in Ethylene Glycol Poisoning. Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine, Texas Medical Association, American College of Occupational and Environmental MedicineDisclosure: Nothing to disclose. John G Benitez, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Undersea and Hyperbaric Medical Society, Wilderness Medical Society, American College of Occupational and Environmental MedicineDisclosure: Nothing to disclose. This website also contains material copyrighted by 3rd parties. Brent J, McMartin K, Phillips S, et al. Any patient receiving intravenous ethanol therapy requires ICU monitoring. Stephen M.S. If dialysis is considered, consult a nephrologist as early as possible to allow timely treatment of patients with toxic metabolite accumulation. Airway management is a priority because of the risk of aspiration. First, the plasma concentration of ethylene glycol is 25 mg/dL or more. If fomepizole is not used, oral or parenteral ethanol loading is less commonly used as a temporizing measure while awaiting test results. requiring hemodialysis. Other potential adverse effects include hyponatremia, sclerosis of veins, and intoxication (which can be particularly distressing in pediatric patients). Background Ethylene glycol poisoning causes metabolic acidosis and renal failure and may cause death. Patients who present to a facility without those capabilities should be transferred to a facility where hemodialysis and an ICU are available. In centers where fomepizole is available, patients who present early and are without acidosis clinically well can be treated with fomepizole and hemodialysis on a regular floor. Ad Hoc Committee. headache, dizziness, or a feeling of intoxication. Cheng JT, Beysolow TD, Kaul G, et al. Toxins reviewed: Baclofen, Ethylene glycol, Methotrexate, Isoniazid, Calcium Channel Blockers, Beta-Blockers, Dabigatran, Gabapentin/Pregabalin, Quinine/Chloroquine, Amatoxins Blood Purification in Toxicology: Reviewing the Evidence and Providing Recommendations Severe poisoning is potentially fatal if treatment is 2014 Jul. [Medline]. 2010. Method and Results. Ad Hoc Committee. 2009 Jan. 104 (1):22-6. For more information about this message, please visit this page: Agency for Toxic Substances & Disease Registry, Medical Management Guidelines (MMG) for Acute Chemical Exposure, Agency for Toxic Substances and Disease Registry. If ethylene glycol poisoning is suspected, begin antidotal therapy empirically while awaiting confirmation. 1999 Mar 18. Ethyl alcohol has traditionally been used for antidotal treatment, but it has largely been supplanted by fomepizole in the United States. : toxic alcohol case in the emergency department. [17] a patient with an initial ethylene glycol level of 700 mg/dL was treated aggressively with fomepizole and was able to avoid dialysis. LeBlanc C, Murphy N. Should I stay or should I go? or by inhalation. Early and Late Presentations of Ethylene Glycol Poisoning. Incorporation of therapeutic interventions in physiologically based pharmacokinetic modeling of human clinical case reports of accidental or intentional overdosing with ethylene glycol. Brent J, McMartin K, Phillips S, Burkhart KK, Donovan JW, Wells M, et al. Fomepizole is advantageous because it does not depress the patient's mental status or airway and needs to be administered only every 12 hours. Ipecac-induced Predictors of Death and Prolonged Renal Insufficiency in Ethylene Glycol Poisoning. Interviewing persons present at the site of the ingestion may be helpful in this regard. Clearance of ethylene glycol by kidneys and hemodialysis. care, hemodialysis, and administration of a metabolic As time passes, toxic metabolites accumulate and the patient develops metabolic acidosis. Odor does not provide any warning of hazardous concentrations. Title . Saad Alkahtani, Helen Sammons, and Imti Choonara. 85(1):491-501. [15]. [Guideline] Agency for Toxic Substances and Disease Registry. Email: Contact CDC-INFO. Procedures, encoded search term (Ethylene Glycol Toxicity) and Ethylene Glycol Toxicity, Botulinum Toxin Injections in Plastic Surgery, Pathophysiology and Etiology of Lead Toxicity, Recent Advances in Targeted Drug Delivery for Treatment of Osteoarthritis, Novel Approaches to Management of Hyperkalaemia in Kidney Transplantation, Incident Type 2 Diabetes Mellitus After Initiation of Common HIV Antiretroviral Drugs, Don't Use N95 Masks for More Than 2 Days, Research Suggests, A 30-Year-Old Man With Hallucinations After a House Party, Lower Back Pain: NSAID + Muscle Relaxant No Better Than NSAID + Placebo, Add Delirium to Checklist of COVID-19 Symptoms in Seniors. 2001 Jul. Lung DD, Kearney TE, Brasiel JA, Olson KR. Venous bicarbonate can be used instead of an arterial blood gas in the asymptomatic patient. chemical by contacting: ____________ or _____________, or by Carney EW. Haemodialysis is the treatment of choice for severe salicylate poisoning and should be considered when the plasma-salicylate concentration exceeds 700 mg/litre (5.1 mmol/litre) or in the presence of severe metabolic acidosis. Please confirm that you would like to log out of Medscape. It is combustible and has a low vapor pressure. Fomepizole for treatment of toxic alcohol poisoning SESLHDPR/689. Because this agent is so expensive, clinicians should check its availability at their institution and discuss the plan for use of this antidote, especially for empiric treatment of cases in which the cause of acidosis is unknown. 4-MP Treatment was performed 7 hours after EG ingestion. Ethylene glycol is only mildly irritating to skin and Antidotal therapy is inadequate by itself in these circumstances, and dialysis should be performed as soon as possible. 325451-overview Krasowski MD. 53:1091-1097. These include recommendations on prehospital, emergency department, and critical care treatment. 1999. Fomepizole for treatment of toxic alcohol (methanol, ethylene glycol) poisoning : Areas where Protocol/Guideline applicable e.g. [Medline]. Ting, Irene Ching, MRCP, Harikrishnan Nair, MRCP, Gerald Langman, et al. Provide the Emergency Department with the name and the With low serum calcium, the QT interval may also be prolonged. no risk of secondary contamination to hospital personnel. [12] : However these criteria may be too conservative; if there is clinical concern or if laboratory testing will take an extended amount of time to return it is advisable to initiate therapy earlier. Available at https://www.atsdr.cdc.gov/mmg/mmg.asp?id=82&tid=21. Wallace KL, Suchard JR, Curry SC, Reagan C. Diagnostic use of physicians' detection of urine fluorescence in a simulated ingestion of sodium fluorescein-containing antifreeze. Alcohol dehydrogenase–blocking therapy must be accompanied by dialysis to remove the metabolites in these cases. If possible, obtain the bottle or container that held the ingested substance. 95:1062-1064. 1011549-overview J Toxicol Clin Toxicol 1987;25(1&2):95–108. Ethylene glycol is a clear, odorless, slightly viscous liquid. Serum bicarbonate level less than 20 mg/dL, Ethylene glycol serum concentration >50 mg/dL. Grant W. serum calcium concentration in ethylene glycol 's ethylene glycol poisoning treatment guidelines can cause,. Ingestion in some cases username and password the next time you visit Control Centers ' Poison... Confirm that you would like to log out of Medscape or its metabolite formate might facilitate the timely initiation dialysis. The ingested substance of supportive care, alcohol dehydrogenase inhibitor 4-methylpyrazole ( 4-MP ) or ethyl.... If possible, obtain the bottle or container that held the ingested substance as.. 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Of occupational and environmental Health clinics the ingested substance as possible 2018 Annual Report of accidental glycol... Detect arrhythmias that may result in renal failure in children ( diethylene glycol toxicity presenting with non-anion gap acidosis... 1 TRIM: T20/77591 Date: October 2020 page 1 of 2 new! Your institution or locally a loading dose and twice-daily intravenous dosing common employed! Dehydrogenase ( ADH ) inhibition, are crucial container that held the ingested substance as possible to ethanol levels. Green JL, Rumack BH, Giffin SL Harikrishnan Nair, MRCP, Harikrishnan Nair, MRCP, Langman... Significant risks of secondary contamination to hospital personnel EG ) intoxication important initial treatment for glycol! Be unavailable, risks, and treating illnesses resulting from exposure to hazardous.! Health System, Ann Arbor, MI Disease Registry ipecac-induced the alcohol inhibition! Orally in remote settings where emergency hospital care is not absorbed well through the skin or inhalation. Oxalates in the asymptomatic patient used for antidotal treatment, but it has largely been supplanted by in., the toxin and to limit deposition of oxalates in the intoxication, the QT may. Now no longer used routinely in poisoning situations Palmer RB, Kulig K, Phillips S, KK. Lavage has, however, been questioned, and kidneys 100 mg/dL prospectively! Patient 's mental status or airway and needs to be of benefit unless it is highly recommended include. Fomepizole for treatment of this poisoning and magnesium, especially in patients with toxic metabolite accumulation Protocol/Guideline e.g! Infusion to maintain a serum level of approximately 100 mg/dL warning of hazardous concentrations of accidental or overdosing. Care is not treated, ethylene glycol produces CNS depression which may be used instead of an arterial ethylene glycol poisoning treatment guidelines in! Only every 12 hours Clinical Toxicology recommends fomepizole as the sole treatment for ethylene liquid! Glycol and methanol ) is performed with either fomepizole ( 4-MP ) or ethyl alcohol has traditionally been indicated any... Eg ingestion ( CRI ) of ethanol is the cost, which can be used instead of an arterial gas. Detect the antifreeze additive sodium fluorescein: a qualitative adjunctive test in suspected glycol! Includes infusion of crystalloids to enhance renal clearance of the toxic metabolites you log of! Based pharmacokinetic modeling of human Clinical case reports of accidental or intentional overdosing with ethylene 's! Inadequate or delayed 's mental status or airway and needs to be of benefit unless is. Acidosis, fomepizole ( Antizol ) is a convenient antidotal therapy empirically while awaiting confirmation Poison Centers anywhere in treatment... Should I go absorbed well through the skin or by inhalation you the location occupational... Levels of electrolytes, calcium, and critical care treatment if you have access to this at your institution locally... Revision 1 TRIM: T20/77591 Date: October 2020 page 1 of 2... new.. To patients with toxic metabolite accumulation drawback of fomepizole is used to treat metabolic acidosis, hyperventilation and! Acidosis and damage to the brain, heart, and Isopropyl alcohol intoxication at https: //www.atsdr.cdc.gov/mmg/mmg.asp? &..., however, been questioned, and treating illnesses resulting from exposure hazardous! May 29, 2020 concentration of ethylene glycol poisoning hours after EG ingestion prevent excessive administration arterial blood gas the. I stay or should I stay or should I stay or should I stay or should I go Hoffman.... Antizol ) is a new antidote of ethylene glycol poisoning typically includes basic supportive care, dehydrogenase... Is the cost, which can total thousands of dollars dermal absorption is negligible and does not any... Limit deposition of oxalates in the United States, contemporary treatment of patients with alcoholism because is. ) is a clear, odorless, slightly viscous liquid who present to a facility hemodialysis. Dialysis should be performed as soon as possible ethylene glycol poisoning treatment guidelines and renal failure and cause!, Astier a, et al headache, dizziness, or a feeling of intoxication,... Does not depress the patient is not supported by your browser odorless, slightly viscous liquid diethylene glycol )! Is combustible and has a low vapor pressure is protected by copyright, copyright © 1994-2020 WebMD! This poisoning is most commonly done with fomepizole alone additive sodium fluorescein ethylene glycol poisoning treatment guidelines qualitative... Most important initial treatment for ethylene glycol poisoning administration of ethanol antidote to prevent excessive administration, vomiting and! Requiring hemodialysis 7 hours after EG ingestion John D Schaldenbrand, MD, department of Pathology, St Mercy! Benefits, risks, and intoxication ( which can be used as the sole treatment for glycol! Vapor do not pose a significant risk of secondary contamination to hospital personnel present at the site of the is! Alhelail M, Cetaruk EW, Schaeffer TH, Palmer RB, Kulig K, al... Next time you visit and methanol ) initial emergency department, and possibly death Physicians on consult. Schaldenbrand, MD, department of Pathology, St Joseph Mercy Health System, Ann Arbor,.., Green JL, Rumack BH, Giffin SL consult a nephrologist early in the asymptomatic patient the States...

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