Oral Ethanol Treatment for Ethylene Glycol Intoxication

Ethylene glycol is an odorless, sweet-tasting liquid found in industrial solutions such as antifreeze and windshield wiper fluid. Brake fluid, an automobile transmission liquid, contains poisonous alcohols such as glycol ethers and ethylene glycols. The toxicity of ethylene glycol is associated with toxic metabolite production by the liver enzyme alcohol dehydrogenase. Administration of either intravenous ethanol or fomepizole, both of which competitively inhibit ethylene glycol metabolism by alcohol dehydrogenase and can prevent the production and accumulation of the toxic metabolites, can be used as an antidote. A 42-year-old male car mechanic was transferred to our hospital after accidentally ingesting approximately 100 mL of brake fluid. Immediately after ingestion, he threw up most of the ingested liquid; however, he complained of nausea and throat pain and was moved to our emergency department. The patient was successfully treated with administration of oral ethanol in the form of whisky through a nasogastric tube since neither intravenous ethanol nor fomepizole was available in our hospital at the time of his presentation. Our case demonstrates that oral ethanol can be used as an alternative treatment for patients with ethylene glycol intoxication.