Emergency Department Hemodialysis in a Case of Severe Ethylene Glycol Poisoning,☆☆,

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Abstract

A 36-year-old man with a history of depression presented to the emergency department after ingesting approximately 3,000 mL of ethylene glycol antifreeze in a suicide attempt. The patient’s ethylene glycol concentration, 1,889 mg/dL, was higher than any level previously documented in the medical literature. Although his course was complicated by nausea, emesis, lethargy, metabolic acidosis, and kidney failure, the patient survived without persistent kidney failure or other chronic problems. Sustained hemodialysis and ethanol infusion were instituted in the ED, on the basis of the patient’s history, before laboratory confirmation of the ingestion was obtained.

[Johnson B, Meggs WJ, Bentzel CJ: Emergency department hemodialysis in a case of severe ethylene glycol poisoning. Ann Emerg Med January 1999;33:108-110.]

Section snippets

INTRODUCTION

A 36-year-old man presented to our emergency department after ingesting 3,000 mL of ethylene glycol antifreeze in a suicide attempt. Although the patient’s ethylene glycol concentration, 1,889 mg/dL, was higher than any level previously documented in the medical literature, the patient survived without sequelae. This outcome may have been the result of immediate sustained hemodialysis and ethanol infusion in the ED on the basis of the patient’s history and before laboratory confirmation of the

CASE REPORT

A 36-year-old man with a history of depression and prior suicide attempts presented to the ED and stated that he had drunk 3,000 mL of an antifreeze product (containing an unknown concentration of ethylene glycol) 5 hours before presentation. He complained of nausea, vomiting, and increasing drowsiness. His temperature was 37.0°C (98.6°F), pulse 96 with normal sinus rhythm, respirations 22, and blood pressure 110/90 mm Hg. Pulse oximetry showed 100% oxygen saturation on room air. The patient

DISCUSSION

The patient whose case is presented here ingested a massive amount of ethylene glycol. Ingestion was confirmed on the basis of history, calculated osmol gap, and direct measurement of ethylene glycol by gas chromatography. Despite this massive ingestion, the patient fared well, without chronic kidney failure or other chronic sequelae, in spite of having an ethylene glycol concentration higher than any previously reported. Early institution of hemodialysis in the ED, before laboratory

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    Citation Excerpt :

    Similarly, two patients who died had hospital admission ethylene glycol values of 0.97 mmol/L (6 mg/dL) [17] and 1.61 mmol/L (10 mg/dL) [23], with corresponding glycolic acid of 14.5 mmol/L and 17.1 mmol/L. Finally, a study by Moreau et al. [13] included a patient with initial ethylene glycol of 0.81 mmol/L (5 mg/dL) and glycolic acid concentration of 19.5 mmol/L who underwent successful hemodialysis with resolution of the profound metabolic acidosis. Contrarily, patients with very high ethylene glycol values of 90.3 mmol/L (5.6 g/L) [24], 104.8 mmol/L (6.5 g/L) [14], 127.4 mmol/L (7.9 g/L) [21], 130.6 mmol/L (8.1 g/L) [17] and 304.8 mmol/L (18.9 g/L) [25] survived due to rapid therapeutic intervention. In one instance a patient had ethylene glycol of 114.5 mmol/L (7.1 g/L), undetectable glycolic acid, ethanol of 33.9 mmol/L (156 mg/dL) and normal acid-base status [17].

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Address for reprints: William J Meggs, MD, PhD, Department of Emergency Medicine, Room 4W-54, Brody Building, East Carolina University School of Medicine, Greenville, NC 27858-4354.

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