Suicide Attempt by Dual Ethylene Glycol and Rat Poison Ingestion: Case Report

Understanding the substances used in an overdose is informative to potential physiological complications and provides a guide for treatment modalities. This case describes a patient who overdosed on both ethylene glycol and rat poison, leading to a complex recovery. A 57-year-old female patient with a past psychiatric history of depression and alcohol use disorder presented to the emergency department unresponsive after a suicide attempt. The patient was found to have severe high-anion-gap metabolic acidosis, was intubated, and started on a bicarbonate drip and emergent hemodialysis. There was suspicion of toxic ingestion of ethylene glycol, given that lactate on arterial blood gas was significantly higher than serum lactic acid, so intravenous fomepizole was started. The patient's family subsequently found a suicide note in the patient's bedroom alongside a bottle of ethylene glycol and rat poison. Brain imaging revealed multiple lacunar infarcts in the bilateral cerebral hemispheres and diffusion abnormality in the hippocampi. Following medical stabilization and continued cognitive improvement over the course of hospitalization, the patient was discharged and referred to a partial hospitalization program for further psychiatric treatment. Reflecting on the patient's unique hospital course, the overdose on both ethylene glycol and rat poison likely resulted in a physiological state similar to typical ethanol poisoning, with both acute and long-term sequelae. Per standard treatment of care, fomepizole and a bicarbonate drip were started for treatment of both toxicities. From a psychiatric standpoint, the patient's ongoing medical complications requiring hemodialysis resulted in difficulties with a direct discharge to an inpatient psychiatric facility following medical clearance; however, she was appropriate for a partial hospitalization level of care. This case highlights successful treatment that may be useful for those encountering similar patient case presentations.