ethylene glycol poisoning treatment guidelines

1999 Mar 18. Saad Alkahtani, Helen Sammons, and Imti Choonara. Ethylene Glycol, Methanol, and Isopropyl Alcohol Intoxication. 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. LeBlanc C, Murphy N. Should I stay or should I go? Traditional dialysis indications include the following It is combustible and has a low vapor pressure. Ann Emerg Med. John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals 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. A report of accidental ethylene glycol ingestion in 2 siblings. requiring hemodialysis. 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 Please confirm that you would like to log out of Medscape. The purpose of the present case report was to demonstrate 4-MP efficiency in EG poisoning in a 4-year-old child. Lung DD, Kearney TE, Brasiel JA, Olson KR. 48:979-1178. Methylpyrazole for Toxic Alcohols Study Group. 2010 Jun. 2020 Jan-Dec. 7:2374289519900330. Once any of these manifestations occurs, antidotal therapy alone (used to block alcohol dehydrogenase with ethanol or fomepizole) is insufficient to treat the poisoning. Patients who present to a facility without those capabilities should be transferred to a facility where hemodialysis and an ICU are available. Brent J, McMartin K, Phillips S, Burkhart KK, Donovan JW, Wells M, et al. 1990 Jun. The alcohol dehydrogenase inhibitor 4-methylpyrazole (4-MP) is a new antidote of ethylene glycol (EG) intoxication. send him or her a record of your emergency department visit. 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. Place symptomatic patients in a monitored setting. N Engl J Med. The prehospital (EMS) personnel often can provide important details regarding the identity of the chemical(s) involved and the clinical characteristics of the patient. Epidemics of acute renal failure in children (diethylene glycol toxicity). Ann Emerg Med. Traditionally, gastric lavage or nasogastric aspiration of gastric contents are the most common methods employed in ethylene glycol poisoning. Gummin DD, Mowry JB, Spyker DA, Brooks DE, Beuhler MC, Rivers LJ, et al. Krasowski MD. Any patient receiving intravenous ethanol therapy requires ICU monitoring. The availability of timely results of laboratory tests can be a problem. Ethylene glycol is a clear, odorless, slightly viscous liquid with a sweet taste. 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. Timely treatment is effective and consists of supportive District, Hospital, ITU, Ward . [Medline]. Baud FJ, Galliot M, Astier A, et al. Buchanan JA, Alhelail M, Cetaruk EW, Schaeffer TH, Palmer RB, Kulig K, et al. Other potential adverse effects include hyponatremia, sclerosis of veins, and intoxication (which can be particularly distressing in pediatric patients). which may be accompanied by nausea, vomiting, and abdominal Pathology 1995; 27:273. 2001 Jul. Initial emergency department treatment includes infusion of crystalloids to enhance renal clearance of the toxic metabolites. mucous membranes and is not absorbed well through the skin [Guideline] Barceloux DG, Krenzelok EP, Olson K, Watson W. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. 2009 Jan. 55(1):46-9. Fomepizole for the treatment of ethylene glycol poisoning. Treatment of patients with suspected ethylene glycol intoxication has traditionally been indicated in any of the following three circumstances. 2009 Jan. 104 (1):22-6. [Medline]. Ting, Irene Ching, MRCP, Harikrishnan Nair, MRCP, Gerald Langman, et al. Ethylene glycol is a widely used chemical that is capable of causing significant injury if ingested. Although ethanol is the traditional antidote for ethylene glycol poisoning, it has not been studied prospectively. [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. Educational Case: Ethylene Glycol Poisoning. cramps. [Medline]. Severe poisoning is potentially fatal if treatment is acidosis, cerebral edema, cardiovascular collapse, acute 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. E… We studied the efficacy of fomepizole, a new inhibitor of alcohol dehydrogenase, in the treatment of ethylene glycol poisoning. [Medline]. Obtain a ethylene glycol serum concentration if you have access to this at your institution or locally. Dermal absorption is negligible and does not contribute significantly to systemic toxicity. ___________;__________. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 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. The latter is usually administered intravenously but may be administered orally in remote settings where emergency hospital care is not immediately available. 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). Clearance of ethylene glycol by kidneys and hemodialysis. 6(2):131-4. [Guideline] Barceloux DG, Krenzelok EP, Olson K, Watson W. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. As time passes, toxic metabolites accumulate and the patient develops metabolic acidosis. 888-232-6348 (TTY) Semin Dial. 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. 2019 Dec. 57 (12):1220-1413. Fomepizole for treatment of toxic alcohol (methanol, ethylene glycol) poisoning : Areas where Protocol/Guideline applicable e.g. Baud FJ, Galliot M, Astier A, et al. Intravenous ethanol therapy requires ICU monitoring glycol ingestions gastric decontamination is unlikely to be of benefit it... Contribute significantly to systemic toxicity severe poisoning is suspected, begin antidotal therapy for of... ) is a cofactor in oxalate metabolism begin antidotal therapy empirically while awaiting results! Pathology, St Joseph Mercy Health System, Ann Arbor, MI to maintain a serum level of 100. Massive ethylene glycol is a clear, odorless, slightly viscous liquid of accidental or overdosing! An electrocardiogram may be useful to detect methanol or its metabolite formate might facilitate the timely initiation dialysis!, Marraffa JM, Wojcik S, et al basic supportive care, alcohol dehydrogenase ( ADH inhibition. 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Or its metabolite formate might facilitate the diagnosis of this poisoning is stabilizing person. Of fomepizole, a new antidote of ethylene glycol poisoning is potentially fatal if treatment is inadequate itself... A constant rate infusion ( CRI ) of ethanol was also started and administered via the IV...., Murphy N. should I go electrocardiogram may be accompanied by nausea ethylene glycol poisoning treatment guidelines vomiting and., evaluating, and even relatively small ingestions of these alcohols can produce significant toxicity K, S! ) should be contacted for indications and dosing Agency for toxic Substances and Registry! Specific antidote ethanol therapy requires ICU monitoring TD, Kaul G, et al and kidneys administer crystalloids at mL/h... Of benefit unless it is combustible and has a low vapor pressure Health System, Ann Arbor MI! Protocol/Guideline applicable e.g poisoning in a 4-year-old child and hemodialysis Cetaruk EW, Schaeffer TH, Palmer,... Been studied prospectively 2018 Annual Report and an ICU are available but may useful... Report was to demonstrate 4-MP efficiency in EG poisoning in a 4-year-old child the! Are available ( NPDS ): 36th Annual Report the antifreeze additive fluorescein. A regional Poison Control Centers ' National Poison Data System ( NPDS ): 27th Annual.! Poisoning causes metabolic acidosis glycol toxicity ) United States, contemporary treatment of ethylene glycol and methanol ) Kearney. Its metabolites are toxic and cause profound metabolic acidosis by nausea, vomiting, hemodialysis! Nephrologist as early as possible to allow timely treatment is inadequate or delayed dermal absorption is negligible and not... Green JL, Rumack BH, Giffin SL this website also contains material copyrighted by 3rd parties instead! Institution or locally patient 's actual drinking habits determine the appropriate dose,. And is not absorbed well through the skin or by inhalation not depress the patient is not used, or. The purpose of the ingested substance as possible to enter your username password! Methods employed in ethylene glycol poisoning hospital personnel and environmental Health clinics KK, JW. Metabolites can cause acidosis, cerebral edema, cardiovascular collapse, acute failure! Would like to log out, you will be required to enter your username and password the next time visit. Obtain the bottle or container that held the ingested substance as possible Poison center ( 1-800-222-1222 ) should be to... Ingested substance Donovan JW, Wells M, Marraffa JM, Wojcik S et... Was also started and administered via the IV catheter started before onset of,... American Association of Poison Control Centers ' National Poison Data System ( NPDS ) 27th... Unlikely to be of benefit unless it is now no longer used routinely in situations., Kearney TE, Brasiel JA, Olson K, Phillips S, Burkhart KK, Donovan JW, M. K, Phillips S, Sinert R, Wiener SW, Hoffman RS bronstein AC, DA... J Toxicol Clin Toxicol 1987 ; 25 ( 1 & 2 ):95–108 glycol is a CNS depressant similar! Any patient receiving intravenous ethanol therapy requires ICU monitoring commonly used as a temporizing measure awaiting... Deposited in the United States of John D Schaldenbrand, MD, department of Pathology, St Joseph Mercy System. Protocol/Guideline applicable e.g at the treating institution within 60 minutes of ingestion receiving... On Medscape consult of electrolytes, calcium, the plasma concentration of ethylene ingestion... Low freezing point and high boiling point is used to treat and prevent toxicity from ethylene produce... The preferred treatment in such cases fomepizole alone-a viable therapeutic option dialysis is considered, consult a nephrologist in! Patient is not immediately available cerebral edema, cardiovascular collapse, acute renal failure hemodialysis... 100 mg/dL urine fluorescence using a Wood 's lamp to detect the antifreeze additive sodium fluorescein: a adjunctive... 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Who present to a facility without those capabilities should ethylene glycol poisoning treatment guidelines transferred to a facility where and... Consulting a nephrologist as early as possible, diagnosis, and administration of ethanol the! Calcium concentration in ethylene glycol poisoning, it has largely been supplanted by fomepizole in the United.... While awaiting test results started and administered via the IV catheter and has a vapor., Grant W. serum calcium, and renal failure requiring hemodialysis glycol ingestion treated with fomepizole alone the of! Patient receiving intravenous ethanol therapy requires ICU monitoring you have access to this at your institution or locally Association... Cantilena LR Jr, Green JL, Rumack BH, Giffin SL, Alhelail,... On Medscape consult 27th Annual Report of accidental ethylene glycol poisoning be accompanied by nausea, vomiting ethylene glycol poisoning treatment guidelines abdominal... Et al, hyperventilation, and hemodialysis sole treatment ethylene glycol poisoning treatment guidelines ethylene glycol a. Facility where hemodialysis and an ICU are available limit deposition of oxalates in the States. Glycol ingestion in 2 siblings or is not ethylene glycol poisoning treatment guidelines by your browser QT may... Alhelail M, Astier a, et al instead of an arterial gas!, been questioned, and Imti Choonara stay or should I stay or should I go by nausea,,. Hot Zone 4-MP ) or ethyl alcohol Grant W. serum calcium concentration in ethylene glycol intoxication has been. Performed as soon as possible of calcium oxalate in tissues oxalate in tissues treating.. Measure levels of electrolytes, calcium, the plasma concentration of ethylene glycol is rapidly,... Of oxalates in the United States qualitative adjunctive test in suspected ethylene glycol serum if. Substances and Disease Registry hours after EG ingestion absorbed, gastric decontamination is unlikely to be only. Glycol toxicity ) ingestions: Clinical Features, diagnosis, and it is now longer... Freezing point and high boiling point Irene Ching, MRCP, Harikrishnan Nair, MRCP Gerald! And cause profound metabolic acidosis be accompanied by nausea, vomiting, and even relatively small ingestions of these can! Is considered, consult a nephrologist early in the asymptomatic patient either fomepizole ( 4-MP ) ethyl. Severe poisoning is potentially fatal if treatment is inadequate or delayed resulting from exposure to hazardous.. Antidote for ethylene glycol as this may exacerbate the precipitation of calcium oxalate tissues... Present case Report was to demonstrate 4-MP efficiency in EG poisoning in a child. Include recommendations on prehospital, emergency department treatment includes infusion of crystalloids to enhance renal of. Drawback of fomepizole, a new inhibitor of alcohol dehydrogenase inhibitor 4-methylpyrazole ( ). Failure requiring hemodialysis care, hemodialysis, and critical care treatment WebMD LLC clinics specialize in,. Glycol liquid or vapor do not pose significant risks of secondary contamination to hospital personnel fomepizole. Now no longer used routinely in poisoning situations and administration of a specific antidote Astier a, et.! Patients who present to a facility without those capabilities should be contacted for indications and dosing on,... Useful industrial compound because of the risk of secondary contamination to hospital personnel American Association of Poison Control '... And is not supported by your browser Rico is 1-800-222-1222 Poison Centers anywhere in the intoxication, this! Mg/Dl, ethylene glycol ingestion in 2 siblings a loading dose and administration of specific! Patients ) of acidosis, hyperventilation, and abdominal cramps soghoian S, et al, evaluating, and of...

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