Severe ethylene glycol toxicity leading to persistent kidney disease

Ethylene glycol toxicity poses a significant global health challenge, especially in low-income countries where it contaminates cough syrups. While global incidence is under-reported compared with the USA, mortality rates are much higher. In the USA, toxicity typically results from accidental ingestion. We report a man in his late 70s with hypertension who presented after being found unresponsive following a seizure. Laboratory findings showed severe anion gap metabolic acidosis with elevated osmolar gap, elevated lactate, acute kidney injury and urinary calcium oxalate crystals. Serum ethanol was <10 mg/dL. Suspecting ethylene glycol ingestion, he received emergency treatment with fomepizole, thiamine, pyridoxine and haemodialysis. Ethylene glycol concentration was confirmed at 188 mg/dL (reference: 0 mg/dL) 3 days postadmission. At a 2-month follow-up, his serum creatinine remained elevated. This case emphasises the critical importance of early recognition and rapid intervention in ethylene glycol toxicity to prevent severe complications and reduce long-term renal damage.