Which medications in the drug class Antidotes are used in the treatment of Ethylene Glycol Toxicity?

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

Antidotes

Fomepizole (Antizol)

Antidote with better safety profile than ethanol. Easier to dose and administer. In contrast to ethanol, fomepizole levels do not need to be monitored during therapy. The biggest drawback is the cost of the antidote; however, compare the additional expenses of fomepizole with the high degree of required vigilance, need for intensive care unit monitoring, occasional treatment failure, and complications seen with ethanol.

Begin fomepizole treatment immediately upon suspicion of ethylene glycol ingestion based on patient history or anion gap metabolic acidosis, increased osmolar gap, oxalate crystals in urine, or documented serum methanol level.

Ethanol

Goal is to maintain blood ethanol concentrations at 100-150 mg/dL. This completely saturates alcohol dehydrogenase (ADH). May be administered PO or IV, but IV is preferred if available. Measuring initial blood concentration is important; if >100 mg/dL, loading dose may be unnecessary and patient can be started on maintenance dose.

Frequent monitoring of blood ethanol concentrations is important, with adjustment of the infusion rate to maintain the serum concentration in the therapeutic range.


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