Complete recovery after repeated suicidal ethylene glycol ingestion

We report here on a patient who attempted suicide four times by ingesting a lethal dose of antifreeze. Reversibility of renal damage due to ethylene glycol (EG) ingestion is not complete in all patients, and its predictor factors are not well understood. A 30-year-old man suffering from a depressive disorder repeatedly attempted suicide between 2002 and 2005. In December 2002 the patient was admitted in a coma. EG intoxication was confirmed (serum EG level 1.025 g/l) and intensive therapy was started (sodium bicarbonate, ethanol, haemodialysis). After treatment he recovered. In February 2003 this patient again drank EG (serum EG level 0.257 g/l). On admission he had no symptoms of intoxication and received only ethanol i.v. Only mild metabolic acidosis (pH = 7.365) developed. In May 2003 the patient arrived at the hospital six hours after ingestion of 500 ml of EG (serum EG level 0.282 g/l). Metabolic acidosis (pH = 7.176) and signs of nephrotoxicity (serum creatinine 168 micromol/l) had developed, for which he received intensive therapy. In May 2005 the patient was found comatose on the street. Laboratory monitoring on admission showed severe metabolic acidosis (pH = 6.899) and a serum EG level of 2.877 g/l. Intensive therapy was performed again. This case report describes for the first time the repeated ingestion of a large amount of EG by a single patient and documents the improvement of renal functions. These findings support the opinion of full recovery in patients with intensive treatment and no history of kidney damage.