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Ethylene glycol ingestion masked by concomitant ethanol intoxication
1Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, Tennessee, USA. justin.head@lmunet.edu
BMJ Case Reports
|May 19, 2012
Summary
A male patient with alcohol abuse presented with severe metabolic and lactic acidosis, initially treated for alcohol intoxication. Prompt hemodialysis was crucial for managing ethylene glycol poisoning, leading to recovery without long-term neurological deficits.
Area of Science:
- Toxicology
- Nephrology
- Emergency Medicine
Background:
- Alcohol abuse can present with severe metabolic disturbances.
- Ethylene glycol poisoning is a life-threatening condition often mimicking alcohol intoxication.
- Early recognition and intervention are critical for patient outcomes.
Observation:
- A patient with a history of alcohol abuse presented with obtundation, metabolic acidosis, and an elevated osmolar gap.
- Initial treatment for alcohol intoxication was initiated due to a high blood alcohol level.
- Despite negative bedside testing for ethylene glycol, the patient developed severe acidosis, renal failure, and a significantly elevated osmolar gap.
Findings:
- The patient exhibited profound metabolic acidosis (pH 6.8), severe lactic acidosis (>56 mmol/l), and a large osmolar gap (407).
- Renal function rapidly declined, necessitating emergency hemodialysis.
- Despite the initial presentation and severity of metabolic derangements, the patient showed neurological improvement and was extubated.
Implications:
- This case highlights the importance of considering ethylene glycol poisoning even with negative initial bedside tests in patients with severe acidosis and elevated osmolar gaps.
- Aggressive management, including hemodialysis, can be life-saving and prevent long-term complications.
- The diagnostic challenges and management strategies for toxic ingestions require a high index of suspicion and prompt intervention.
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