Ethylene Glycol Toxicity Medication

Updated: Dec 05, 2017
  • Author: Daniel C Keyes, MD, MPH; Chief Editor: Sage W Wiener, MD  more...
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Medication

Medication Summary

If ethylene glycol poisoning is suspected, begin antidotal therapy empirically while awaiting confirmation. Antidotes are fomepizole and ethanol. B-vitamin therapy may be used as an adjunct to antidotal therapy.

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Antidotes

Fomepizole (Antizol)

Antidote with better safety profile than ethanol. Easier to dose and administer. In contrast to ethanol, fomepizole levels do not need to be monitored during therapy. The biggest drawback is the cost of the antidote; however, compare the additional expenses of fomepizole with the high degree of required vigilance, need for intensive care unit monitoring, occasional treatment failure, and complications seen with ethanol.

Begin fomepizole treatment immediately upon suspicion of ethylene glycol ingestion based on patient history or anion gap metabolic acidosis, increased osmolar gap, oxalate crystals in urine, or documented serum methanol level.

Ethanol

Goal is to maintain blood ethanol concentrations at 100-150 mg/dL. This completely saturates alcohol dehydrogenase (ADH). May be administered PO or IV, but IV is preferred if available. Measuring initial blood concentration is important; if >100 mg/dL, loading dose may be unnecessary and patient can be started on maintenance dose.

Frequent monitoring of blood ethanol concentrations is important, with adjustment of the infusion rate to maintain the serum concentration in the therapeutic range.

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Nutrients

Class Summary

Pyridoxine enhances metabolism of glyoxylate to glycine. Thiamine catalyzes metabolism of glyoxylate from glycolic acid. Vitamin therapy is a safe and reasonable adjunct in patients with ethylene glycol poisoning. Regional poison centers may suggest the use of these therapies in certain cases.

Pyridoxine (Nestrex)

Water-soluble vitamin B6, which is a cofactor in conversion of GA to nonoxalate compounds. Involved in synthesis of GABA within CNS.

Thiamine (Thiamilate)

Vitamin B-1 is water-soluble and used in many cellular functions that involve energy formation and use. Promotes conversion of glyoxylate to a nontoxic metabolite, alpha-hydroxy-beta-ketoadipate.

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