Toxicity, Ethylene Glycol Follow-up

  • Author: Daniel C Keyes, MD, MPH; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Jan 25, 2010
 

Further Inpatient Care

Patients who require antidotal therapy or dialysis require admission to an ICU or other setting with cardiac monitoring and close nursing care.

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Transfer

Patients with serious ethylene glycol intoxications, particularly those who have presented at the time when metabolic acidosis is developing or already exists, should be transferred to a facility where hemodialysis is available.

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Contributor Information and Disclosures
Author

Daniel C Keyes, MD, MPH  Vice Chair, Academic Affairs, Department of Emergency Medicine, John Peter Smith Health Network; Clinical Associate Professor, Department of Surgery, Division of Emergency Medicine and Toxicology, University of Texas Southwestern School of Medicine

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, and American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT  Associate Clinical Professor; Medical and Managing Director, South Texas Poison Center, Department of Surgery/Emergency Medicine and Toxicology, University of Texas Health Science Center at San Antonio

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

John G Benitez, MD, MPH, FACMT, FAACT, FACPM, FAAEM,  Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center

John G Benitez, MD, MPH, FACMT, FAACT, FACPM, FAAEM, 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, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References
  1. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). Dec 2008;46(10):927-1057. [Medline]. [Full Text].

  2. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 2008 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 26th Annual Report. Clin Toxicol (Phila). Dec 2009;47(10):911-1084. [Medline]. [Full Text].

  3. Long H, Nelson LS, Hoffman RS. A rapid qualitative test for suspected ethylene glycol poisoning. Acad Emerg Med. Jul 2008;15(7):688-90. [Medline].

  4. LeBlanc C, Murphy N. Should I stay or should I go?: toxic alcohol case in the emergency department. Can Fam Physician. Jan 2009;55(1):46-9. [Medline].

  5. [Guideline] Caravati EM, Erdman AR, Christianson G, Manoguerra AS, Booze LL, Woolf AD, et al. Ethylene glycol exposure: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(5):327-45. [Medline]. [Full Text].

  6. [Guideline] Barceloux DG, Krenzelok EP, Olson K, Watson W. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. Ad Hoc Committee. J Toxicol Clin Toxicol. 1999;37(5):537-60. [Medline].

  7. Druteika DP, Zed PJ, Ensom MH. Role of fomepizole in the management of ethylene glycol toxicity. Pharmacotherapy. Mar 2002;22(3):365-72. [Medline].

  8. Corley RA, McMartin KE. Incorporation of therapeutic interventions in physiologically based pharmacokinetic modeling of human clinical case reports of accidental or intentional overdosing with ethylene glycol. Toxicol Sci. May 2005;85(1):491-501. [Medline]. [Full Text].

  9. Green R. The management of severe toxic alcohol ingestions at a tertiary care center after the introduction of fomepizole. Am J Emerg Med. Sep 2007;25(7):799-803. [Medline].

  10. Megarbane B, Borron SW, Baud FJ. Current recommendations for treatment of severe toxic alcohol poisonings. Intensive Care Med. Feb 2005;31(2):189-95. [Medline].

  11. Velez LI, Shepherd G, Lee YC, Keyes DC. Ethylene glycol ingestion treated only with fomepizole. J Med Toxicol. Sep 2007;3(3):125-8. [Medline].

  12. Baud FJ, Galliot M, Astier A, Bien DV, Garnier R, Likforman J. Treatment of ethylene glycol poisoning with intravenous 4-methylpyrazole. N Engl J Med. Jul 14 1988;319(2):97-100. [Medline].

  13. Brent J. Current management of ethylene glycol poisoning. Drugs. 2001;61(7):979-88. [Medline].

  14. Brent J, McMartin K, Phillips S, et al. Fomepizole for the treatment of ethylene glycol poisoning. Methylpyrazole for Toxic Alcohols Study Group. N Engl J Med. Mar 18 1999;340(11):832-8. [Medline].

  15. Browning RG, Curry SC. Clinical toxicology of ethylene glycol monoalkyl ethers. Hum Exp Toxicol. May 1994;13(5):325-35. [Medline].

  16. Burkhart K. Methanol and ethylene glycol toxicity. J Toxicol Clin Toxicol. 1997;35(2):149-50. [Medline].

  17. Carney EW. An integrated perspective on the developmental toxicity of ethylene glycol. Reprod Toxicol. Mar-Apr 1994;8(2):99-113. [Medline].

  18. Church AS, Witting MD. Laboratory testing in ethanol, methanol, ethylene glycol, and isopropanol toxicities. J Emerg Med. Sep-Oct 1997;15(5):687-92. [Medline].

  19. Darchy B, Abruzzese L, Pitiot O, et al. Delayed admission for ethylene glycol poisoning: lack of elevated serum osmol gap. Intensive Care Med. Aug 1999;25(8):859-61. [Medline].

  20. Davis DP, Bramwell KJ, Hamilton RS, Williams SR. Ethylene glycol poisoning: case report of a record-high level and a review. J Emerg Med. Sep-Oct 1997;15(5):653-67. [Medline].

  21. Glaser DS. Utility of the serum osmol gap in the diagnosis of methanol or ethylene glycol ingestion. Ann Emerg Med. Mar 1996;27(3):343-6. [Medline].

  22. Sabeel AI, Kurkus J, Lindholm T. Intensified dialysis treatment of ethylene glycol intoxication. Scand J Urol Nephrol. Jun 1995;29(2):125-9. [Medline].

  23. 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. Ann Emerg Med. Jul 2001;38(1):49-54. [Medline].

  24. Winter ML, Ellis MD, Snodgrass WR. Urine fluorescence using a Wood's lamp to detect the antifreeze additive sodium fluorescein: a qualitative adjunctive test in suspected ethylene glycol ingestions. Ann Emerg Med. Jun 1990;19(6):663-7. [Medline].

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