When is treatment for suspected ethylene glycol (EG) intoxication indicated?

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

Treatment of patients with suspected ethylene glycol intoxication has traditionally been indicated in any of the following three circumstances. First, the plasma concentration of ethylene glycol is 25 mg/dL or more. Second, the patient has a definite history of recent ethylene glycol ingestion (especially if the osmolal gap is 10 mOsm/L or more, though patients with potentially toxic ethylene glycol ingestions may have an apparently normal osmolar gap; see Workup/Laboratory Studies). Third, a history or suspicion of ethylene glycol intoxication and the presence of at least two of the following [11] :

  • Arterial pH less than 7.3
  • Serum bicarbonate level less than 20 mg/dL
  • Osmol gap greater than 10 mOsm/L
  • Oxalate crystals in the urine

However these criteria may be too conservative; if there is clinical concern or if laboratory testing will take an extended amount of time to return it is advisable to initiate therapy earlier. A review of 121 ethylene glycol poisoning cases found that patients who did not receive an antidote (ethanol and/or fomepizole) until more than 6 hours had passed had higher odds of dying or having prolonged renal insufficiency (odds ratio 3.34). [12]


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