What is the initial emergency department (ED) treatment of ethylene glycol (EG) toxicity?

Updated: Dec 05, 2017
  • Author: Daniel C Keyes, MD, MPH; Chief Editor: Sage W Wiener, MD  more...
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Answer

Initial emergency department treatment includes infusion of crystalloids to enhance renal clearance of the toxic metabolites. Ethyl alcohol has traditionally been used for antidotal treatment, but it has largely been supplanted by fomepizole in the United States.

 In centers where fomepizole is available, patients who present early and are without acidosis clinically well can be treated with fomepizole and hemodialysis on a regular floor. Any patients who are ill and acidotic or who present to centers where ethanol is used instead of fomepizole should be treated in an intensive care unit (ICU) or other setting with cardiac monitoring and close nursing care. Patients who present to a facility without those capabilities should be transferred to a facility where hemodialysis and an ICU are available.


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