Ethylene glycol and methanol poisonings: case series and review

Ethylene glycol (EG) and methanol (MTH) are common industrial solvents and are responsible for accidental, suicidal, and epidemic poisonings.1 Since the clinical signs and symptoms associated with EG and MTH poisoning are nonspecific, it is important for the medical community to consider these toxicities given that early treatment prevents death.2 The hallmark of toxic alcohol poisoning is a combination of a high anion gap metabolic acidosis and osmolar gap.3 In order to determine laboratory abnormalities and outcomes associated with EG and MTH ingestion at our institution, a retrospective chart review was obtained.

A retrospective chart review of all adult patients admitted to our institution with a diagnosis of EG or MTH intoxication during a 15-year period was done. Age, sex, EG and MTH levels, degree of acidosis, initial anion and osmolar gaps, renal dysfunction, length of stay in the hospital, need for dialysis, and ADH (alcohol dehydrogenase) blockade treatment were recorded. Hospital outcome included renal function and need for dialysis at hospital discharge.

The study population consisted of 14 patients.The mean pH was 7.02. The mean anion gap and osmolar gap were 21 meq/l and 48 mOsm/l correspondingly. All patients underwent treatment with either ethanol or fomepizole and hemodialysis. At discharge, three patients had renal insufficiency not requiring dialysis; one remained on dialysis, while seven regained normal renal function.

Most patients with EG and MTH intoxication have a decreased level of consciousness making an adequate history unobtainable. One must rely on laboratory data for clues in making a diagnosis of intoxication. A review of the clinical features, pharmacokinetics, laboratory analysis, and management of EG and MTH poisoning is included in this discussion to help raise medical community awareness of this entity.