2 A patient’s urine may also fluoresce under black light due to the addition of fluorescein to ethylene glycol (although this finding is not sensitive or specific). Laboratory hallmarks that support the diagnosis of ethylene glycol ingestion include an increased osmolar gap, calcium oxalate crystals on urinalysis (UA), and renal dysfunction. However, with proper medical intervention, many of its toxic effects can be prevented.Īffected individuals may suffer from end-organ dysfunction, particularly renal failure, and subsequent death without proper intervention. 2 While ethylene glycol is not directly toxic to the body, it has toxic metabolites, including the nephrotoxic oxalic acid. 1 It has been reported that 18.1% of ethylene glycol exposures died when treated with ethanol, while 4.1% died when treated with fomepizole. 1 Nonspecific symptoms such as depressed mental status with ingestion of either substance may lead providers to misdiagnose ethylene glycol for ethanol intoxication unless a high level of suspicion is maintained, and the morbidity of ethylene glycol ingestion is significant, with more than 6,000 exposures and 22 deaths in the US in 1998. Poison control centers have reported between 40 cases of ethylene glycol exposures per year. Introduction:Įthylene glycol is a component of antifreeze and engine coolant, and its ingestion is much less common than ethanol intoxication. The principles of crisis resource management, teamwork, and communication are incorporated into the case. This case is also appropriate for senior medical students and advanced practice providers. This scenario was developed to educate emergency medicine residents on the diagnosis and management of ethylene glycol ingestion.
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