Intoxicación por etilenglicol / Intoxication due to ethylene glycol

Resumen La intoxicación por etilenglicol es una urgencia médica y debe ser tratada como tal. El diagnóstico puede efectuarse con la existencia de acidosis metabólica con brecha aniónica amplia, aumento de la osmolaridad sérica, cristaluria de monohidrato de oxalato de calcio y lesión renal aguda. Cursa con tres fases bien definidas, aunque algunos autores consideran una cuarta. Puede prescribirse etanol oral asociado con hemodiálisis en los sitios donde no hay disponibilidad de fomepizol o de etanol para administración parenteral.

Abstract Ethylene glycol poisoning is a medical urgency and must be treated as so. Diagnosis can be achieved by metabolic acidosis with the pres ence of a wide anion gap, increase in serum osmalarity, cristalluria of calcium oxalate monohidrate and acute renal failure. It courses with three defined phases, although some authors identify a fourth phase. Ethanol can be used, associated to hemodyalisis, in the places where there is not availability for fomepizole or ethanol of parenteral administration.

A Case of Ethylene Glycol intoxication with Acute Renal Injury: Successful Recovery by Fomepizole and Renal Replacement Therapy

Ethylene glycol is a widely used and readily available substance. Ethylene glycol ingestion does not cause direct toxicity; however, its metabolites are highly toxic and can be fatal even in trace amounts. Poisoning is best diagnosed through inquiry, but as an impaired state of consciousness is observed in most cases, poisoning must be suspected when a significantly elevated osmolar gap or high anion gap metabolic acidosis is found in blood tests. Hemodialysis and alcohol dehydrogenase inhibitors such as ethanol and fomepizole are a part of the basic treatment, and timely diagnosis and treatment are crucial because any delays can lead to death. However, there are few reported cases in Korea, and no report on the use of fomepizole. Herein, we report a case of acute renal failure caused by ethylene glycol poisoning that was treated with fomepizole and hemodialysis and present a literature review.

Fomepizole for Ethylene Glycol or Methanol Poisoning in Children

PURPOSE: The purpose of this study is to evaluate the effectiveness and adverse effect of fomepizole in the management of acute ethylene glycol or methanol poisoning in children. METHODS: Databases such as PubMed, Embase, Cochrane library, and KoreaMed were searched using terms related to fomepizole, ethylene glycol, methanol and pediatric. All studies, regardless of study design, reporting effectiveness or safety endpoints in children were included. Reference citations from identified publications were reviewed. Only reports written in English or Korean languages were included. The reference search was performed by two authors. RESULTS: Twenty-two relevant literatures were finally included. They were one narrative review, 4 retrospective case series, and 17 case reports (19 cases). Case reports were classified as 5 fomepizole only, 8 fomepizole with other therapies, and 6 no fomepizole. All patients from the literatures were fully recovered without long term sequelae. Adverse effects of fomepizole were reported including anaphylaxis, thrombophlebitis and nystagmus. CONCLUSION: There are insufficient literatures regarding fomepizole treatment in children with ethylene glycol or methanol poisoning. The benefits or harms are not clearly established based on the clinical evidences. More prospective comparative studies are required in the future.

Muerte cerebral secundaria a intoxicación por metanol / Brain death secondary to methanol poisoning

Las intoxicaciones por alcohol metílico son raras, pueden ser secundarias a intentos suicidas, accidentes e incluso a envenenamientos endémicos, tienen consecuencias severas que incluyen la muerte, secundarias a productos de la degradación del alcohol metílico por la alcohol deshidrogenasa, a continuación, presentamos un caso de intoxicación por alcohol metílico que como secuelas presentó alteraciones neurológicas y muerte. (Acta Med Colomb 2012; 37: 211-214).

Methyl alcohol poisoning is rare and may be secondary to suicide attempts, accidents and is also caused by endemic poisonings. It has severe consequences including death secondary to degradation products of methyl alcohol by alcohol dehydrogenase. We present a case of methyl alcohol poisoning that presented neurological alterations and death. (Acta Med Colomb 2012; 37: 211-214).

Intoxicación con etilenglicol. Presentación de casos y revisión de la literatura / Intoxication with ethylene glycol. Presentation of cases and review of literature

El etilénglicol es un producto utilizado en la industria química. La ingesta o aspiración de esta sustancia es una emergencia médica que se debe diagnos� ticar y tratar de inmediato. Inicialmente produce un cuadro conocido como "embriaguez sin aliento alcohólico", seguido de toxicidad cardiopulmonar y renal con grave acidosis metabólica con brecha aniónica aumentada. En la mayoría de los Centros, no es posible determinar la concentración de eti� lénglicol en sangre, por lo que el diagnóstico inicial se basa en la anamnesis y en la presencia de acidosis metabólica grave con brecha aniónica elevada. El tratamiento consiste en soporte vital, adecuada infusión de fluidos y bicar� bonato de sodio, administración de etanol o fomepizol para antagonizar la enzima alcohol deshidrogenasa y, en algunos casos, hemodiálisis.(AU)

The ethylene glycol is a product used in the chemical industry. The intake or inhalation of this substance is a medical emergency that should be diagnosed and treated early. Initially it causes a condition known as "drunkenness with� out alcoholic breath", followed by cardiopulmonary and renal dysfunctions with severe metabolic acidosis and increased anion gap. Determination of blood levels is not available in most health care centers, so initial diagnosis should be based on history and the presence of metabolic acidosis with el� evated anion gap. Treatment consists of vital support, adequate fluid and bicarbonate infusion, administration of ethanol o fomepizole to antagonize the � genase and, in some cases, hemodialysis.(AU)