It was only about two weeks after presentation that the history of ethylene glycol ingestion one week before presentation was confirmed. [jmedicalcasereports.com]

Early empiric ethanol therapy and consideration of dialysis are recommended for those patients with such a presentation without evidence of abnormal levels of ketones, lactate, salicylate, or ethanol. [ncbi.nlm.nih.gov]

Given the level of toxicological awareness evidenced by this case presentation, it’s fortunate that the patient did well. [thepoisonreview.com]

• Asymptomatic

  […] potentially malicious administration should be referred to an emergency department immediately regardless of the dose reported (Grade D). (2) Patients with inhalation exposures will not develop systemic toxicity and can be managed out-of-hospital if asymptomatic [ncbi.nlm.nih.gov]

  Fomepizole should be continued until the serum ethylene glycol level is < 20 mg/dl and the patient is asymptomatic with a normal serum pH. [renalandurologynews.com]

  Screening for Hepatitis C | CTFPHC Review Canadian Task Force on Preventive Health Care guideline on Hepatitis C screening REFERENCE BOOK Screening for Abdominal Aortic Aneurysm | CTFPHC REFERENCE BOOK Impaired Vision | CTFPHC REFERENCE BOOK Screening for Asymptomatic [qxmd.com]

  Initially, patients may be asymptomatic, but ethylene glycol is rapidly absorbed (within 1 to 4 hours), and altered mental status and tachypnea then begin to appear as the ethylene glycol is successively metabolized to very toxic compounds. [emedicine.com]

• Weakness

  The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. [ncbi.nlm.nih.gov]

  Hemodialysis was instituted, however his renal function did not return and a week into his hospitalization, he developed flaccid extremity weakness and bilateral facial weakness. [calpoison.org]

  The signs of EG poisoning include excessive thirst and urination, lack of coordination, weakness, nausea, tremors, vomiting, rapid breathing and heart rate, convulsions, diarrhea, and paralysis. [web.archive.org]

  Relevant Paper(s) Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses Borron SW et al, 1999, France 38 acute poisonings of which 11 patients had plasma ethylene glycol concentrations of 0.20g/l or [bestbets.org]

  As a weak acid, formic acid should become more water soluble in an alkaline bloodstream, and in alkaline urine. [derangedphysiology.com]

• Unconsciousness

  CASE REPORT In this case report, we present a patient who was admitted unconscious to the hospital. [ncbi.nlm.nih.gov]

  Fourteen patients developed metabolic acidosis, nine unconsciousness, thirteen signs of nephrotoxicity and nine signs of hepatotoxicity. Three patients died. Antidote ethanol was given in 30 patients. [doi.org]

• Fatigue

  **Subjects complaining of fatigue or ataxia were considered symptomatic. [doi.org]

• Pallor

  Infants can demonstrate irritability, lethargy, vomiting, pallor, hypotonia, and poor feeding 24&25 Saladino R, Shannon M. [doi.org]

• Vomiting

  Signs of walking drunk, drooling/hypersalivating, vomiting, seizuring, vomiting, and excessive thirst and urination are seen. [web.archive.org]

  During the first hours of ethylene glycol poisoning, the patient suffers from drunkenness, vomiting and somnolence due to the intoxicant effect of ethylene glycol on the central nervous system. [ncbi.nlm.nih.gov]

  After the glycoaldehyde forms (at 4-12 hours) and metabolic acidosis begins, CNS depression—if it is a serious intoxication—can lead to the following effects: seizures coma cerebral edema (in some cases) gastrointestinal irritation (nausea and vomiting [atsdr.cdc.gov]

  EARLY: - CS of CNS depression - Vomiting - ataxia, polyuria, polydipsia - metabolic acidosis characterized by a high anion gap - isosthenuria - calcium oxalate monohydrate or dihydrate crystalluria - hyperosmolality ( if available) - in dogs EG test kit [quizlet.com]

• Nausea

  After the glycoaldehyde forms (at 4-12 hours) and metabolic acidosis begins, CNS depression—if it is a serious intoxication—can lead to the following effects: seizures coma cerebral edema (in some cases) gastrointestinal irritation (nausea and vomiting [atsdr.cdc.gov]

  Signs and Symptoms of Antifreeze Poisoning Nausea Vomiting Abdominal pain Frequent and/or painful urination Kidney pain and eventually kidney failure Dizziness Stupor similar to intoxication (drunkeness) Shortness of breath ( dyspnea ) Rapid breathing [healthhype.com]

  Abstract We report a case of a 75-year-old hypertensive, diabetic man who presented to the emergency room with symptoms and signs of nausea, acute intoxication, significant alteration in mental status with rapid neurologic deterioration, and blunt impact [doi.org]

  Ethylene Glycol Toxicity Stage 1: Intoxication Up to 12 hours post-ingestion An ethanol-like intoxicated state (without an appropriate odour on the breath) progressing to CNS depression Fits and coma may occur A high anion gap metabolic acidosis develops Nausea [anaesthesiamcq.com]

• Abdominal Pain

  Case presentation A 53-year-old Afro-Caribbean man was admitted to another institution with a two-day history of vomiting, hiccups and abdominal pain. [jmedicalcasereports.com]

  Signs and Symptoms of Antifreeze Poisoning Nausea Vomiting Abdominal pain Frequent and/or painful urination Kidney pain and eventually kidney failure Dizziness Stupor similar to intoxication (drunkeness) Shortness of breath ( dyspnea ) Rapid breathing [healthhype.com]

  The first phase typically involves gastrointestinal effects such as nausea, vomiting, abdominal pain and diarrhea. Patients may be inebriated and mild hypotension has been reported. [calpoison.org]

  EG can cause nausea, vomiting, slurred speech, dizziness, unsteady gait, and abdominal pain. A person who is poisoned with EG may appear drunk. They may also have a sweet aromatic odor to their breath. [acmt.net]

• Diarrhea

  Diseases and Disorders section features more than 300 new figures and tables, as well as 20 new topics including: cyclic vomiting syndrome, traveler’s diarrhea, chronic pruritus, post-herpetic neuralgia, enteropathic arthritis, and hoarding disorder. [books.google.com]

  The first phase typically involves gastrointestinal effects such as nausea, vomiting, abdominal pain and diarrhea. Patients may be inebriated and mild hypotension has been reported. [calpoison.org]

  The signs of EG poisoning include excessive thirst and urination, lack of coordination, weakness, nausea, tremors, vomiting, rapid breathing and heart rate, convulsions, diarrhea, and paralysis. [web.archive.org]

  Signs include lethargy, anorexia, dehydration, vomiting, diarrhea, oral ulcers, salivation, tachypnea, and possibly seizures or coma. The kidneys are often swollen and painful on abdominal palpation. [merckmanuals.com]

• Hypotension

  Serious (life-threatening) adverse drug events occurred in 11 of 130 (8%) ethanol-treated (respiratory depression, hypotension) and 1 of 42 (2%) fomepizole-treated (hypotension, bradycardia) cases. [ncbi.nlm.nih.gov]

  He subsequently became hypotensive (55/39 mmHg) and did not respond to fluid boluses. A dopamine infusion was commenced. [caribbean.scielo.org]

  Hypotension Hypotension may be present due to gastrointestinal fluid loss and alcohol-induced vasodilation, and in such cases fluid replacement with a crystalloid should be performed, having regard to adequate urine output. [toxinz.com]

  Stage 2 (Cardiopulmonary toxicity phase) The following cardiorespiratory symptoms may appear 12-24 hours after ingestion tachycardia, tachypnea, and hypertension or hypotension. [atsdr.cdc.gov]

  Patients may be inebriated and mild hypotension has been reported. Patients may have an abnormal osmolal gap and develop an anion gap metabolic acidosis. [calpoison.org]

• Renal Insufficiency

  Eventually, oxalate is deposited in the kidney and elsewhere; renal insufficiency may ensue. [emedicine.medscape.com]

  When ingested in the form of antifreeze or other automotive products, ethylene glycol results in central nervous system depression, cardiopulmonary compromise, and renal insufficiency. [ncbi.nlm.nih.gov]

• Kidney Failure

  Delayed treatment often is not effective, and once a dog or cat has developed kidney failure, the prognosis is poor. [web.archive.org]

  […] tissue produces renal tubular necrosis that leads to kidney failure. [ncbi.nlm.nih.gov]

• Oliguria

  A young man presented to the emergency department with mental status changes, severe metabolic acidosis, and oliguria. Acute ethylene glycol intoxication was diagnosed. [ncbi.nlm.nih.gov]

  History / PE : Flank pain, hematuria, oliguria (ARF) Diagnosis : Anion gap acidosis Elevated creatinine Calcium oxalate crystal deposition in kidneys Treatment : 1) Fomepizole or ethanol ( ADH inhibition) 2) Sodium bicarbonate (correct acidosis) 3) Hemolysis [medlibes.com]

  […] polydipsia - metabolic acidosis characterized by a high anion gap - isosthenuria - calcium oxalate monohydrate or dihydrate crystalluria - hyperosmolality ( if available) - in dogs EG test kit LATE: - depression - anorexia, vomiting - azotemia, and oliguria [quizlet.com]

  Collins JM, Hennes DM, Holzgang CR, Gourley RT, Porter GA. (1970) Recovery after prolonged oliguria due to ethylene glycol intoxication. Arch Intern Med 125, 1059-62. Go to original source... Go to PubMed... [doi.org]

• Anuria

  metabolic acidosis characterized by a high anion gap - isosthenuria - calcium oxalate monohydrate or dihydrate crystalluria - hyperosmolality ( if available) - in dogs EG test kit LATE: - depression - anorexia, vomiting - azotemia, and oliguria or anuria [quizlet.com]

  In severe poisonings, renal failure may appear early and progress to anuria. Renal symptoms may last up to 45 days or more. Acute renal failure may prove permanent in a minority of cases. [toxinz.com]

  Due to persistent metabolic acidosis and anuria, emergency hemodialysis was considered for the patient. His mental status improved after hemodialysis and then he confirmed deliberate ingestion of the brake oil. [apjmt.mums.ac.ir]

  If left untreated, patients may die within a week after the onset of anuria. Additionally, mild to moderate hepatotoxicity is often seen. [calpoison.org]

  Our patient's presenting symptoms of abdominal pain, constipation and anuria, along with the investigations revealing raised inflammatory markers, acute renal failure and an abdominal CT which suggested bilateral pyelonephritis, pointed towards a diagnosis [jmedicalcasereports.com]

• Seizure

  Seizures — control with IV benzodiazepines, and intubate and ventilate as required (see above). [lifeinthefastlane.com]

  Parenteral calcium may be necessary for treatment of tetany or seizures caused by hypocalcaemia. Sodium bicarbonate is given to correct the metabolic acidosis. [caribbean.scielo.org]

  RESULTS: The D/RI group was more likely than the RECOV group to present comatose, have seizures, and require intubation. [ncbi.nlm.nih.gov]

  In severe cases, seizures and coma may develop. [toxinz.com]

• Stupor

  Clinical manifestations of the ethylene glycol intoxication can be divided in three phases: a neurologic stage, with hallucinations, stupor and coma; the second stage is cardiovascular with cardiac failure. [ncbi.nlm.nih.gov]

  Signs and Symptoms of Antifreeze Poisoning Nausea Vomiting Abdominal pain Frequent and/or painful urination Kidney pain and eventually kidney failure Dizziness Stupor similar to intoxication (drunkeness) Shortness of breath ( dyspnea ) Rapid breathing [healthhype.com]

  Symptoms may include nausea, vomiting, convulsions, stupor (decreased level of alertness), or even coma. [nlm.nih.gov]

• Headache

  He had experienced headache the previous day but had been otherwise well. Investigations revealed a severe metabolic acidosis, raised lactate and acute kidney injury. [ncbi.nlm.nih.gov]

  Ethylene glycol kills by first affecting the central nervous system, causing symptoms such as headache, confusion, slurred speech and tremors, according to ATSDR. [foxnews.com]

  […] elevated serum creatinine at last study reading Ethylene glycol metabolites All patients demonstrated progressive reduction in blood glycolate concentration Cranial neuropathies 0/19 patients Side effects 2 patients had seizures, 2 patients experienced headaches [bestbets.org]

  Diagnosis of Dementia with Lewy Bodies (DLB) Diagnose patients with dementia with Lewy Bodies based on the 2017 criteria Arteriovenous Malformation Coma/Level of Consciousness Demyelinating Disease Dermatome Map Functional Outcome Head & Neck Trauma Headache [qxmd.com]

• Nystagmus

  This state of alcohol intoxication occurs within 1-2 hours and is characterized by euphoria, nystagmus, drowsiness, nausea and vomiting. The patient has a high osmolar gap. [lifeinthefastlane.com]

  Stage 1 (0,5 to 12 hours) consist of neurological and gastrointestinal symptoms; people may appear to be intoxicated, exhibiting symptoms such as dizziness, incoordination of muscles movements, nystagmus, headaches, slurred speech and confusion. [flipper.diff.org]

  […] respirations Hyperkalemia Elevated anion and osmolar gaps Severe metabolic acidosis Seizures Acute kidney injury Multiple organ failure Cranial nerve defects Coma Death CHRONIC EFFECTS General Effects Chronic exposures to ethylene glycol vapor may result in nystagmus [toxinz.com]

  Neurological manifestations are apparent within 0.5–12 h of ingestion and include inebriation in the absence of detectable ethanol on breath or in blood, nausea, vomiting, nystagmus, papilledema, depressed reflexes, convulsions, and coma. [web.archive.org]

• Papilledema

  Neurological manifestations are apparent within 0.5–12 h of ingestion and include inebriation in the absence of detectable ethanol on breath or in blood, nausea, vomiting, nystagmus, papilledema, depressed reflexes, convulsions, and coma. [web.archive.org]

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 [emedicine.medscape.com]

In the United States, contemporary treatment of this poisoning is most commonly done with fomepizole alone. [emedicine.medscape.com]

We studied the efficacy of fomepizole, a new inhibitor of alcohol dehydrogenase, in the treatment of ethylene glycol poisoning. [ncbi.nlm.nih.gov]

Although severe acidosis in the presence of serious illness is usually associated with a poor prognosis, our case emphasized the importance of aggressive supportive care and antidotal therapy for ethylene glycol poisoning even when there is a low pH. [ncbi.nlm.nih.gov]

Treatment and prognosis With prompt and appropriate therapy, ethylene glycol toxicity can be minimised. Treatment is primarily with haemodialysis, administration of bicarbonate (to counteract metabolic acidosis), and fomepizole 1. [radiopaedia.org]

The etiology of the central nervous system, metabolic, cardiopulmonary, and renal toxicities are primarily due to the formation and accumulation of toxic intermediary metabolites, especially aldehyde metabolites 9 Parry M F, Wallach R. [doi.org]

Primary Entity http://www.worldcat.org/oclc/705256734 > # Journal of exposure analysis and environmental epidemiology official publication of the International Society of Exposure Analysis (ISEA). a schema:CreativeWork, schema:MediaObject, schema:Periodical [worldcat.org]

He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]

Epidemiology Frequency United States Ethylene glycol is a relatively common cause of overdose in US emergency departments. [emedicine.com]

Epidemiology A significant number of poisonings with ethylene glycol occur in California each year. In calendar year 2000, the CPCS consulted on 469 exposures to EG. [calpoison.org]

A comprehensive review of the literature on the pathology and pathophysiology of ethylene glycol toxicity on each organ system is provided, along with information on diagnosis and current treatment recommendations. [ncbi.nlm.nih.gov]

The pathophysiologic basis of medical toxicology: the organ system approach -- Part. D. [worldcat.org]

In addition to the pathophysiology and clinical findings in poisoning, recent evidence for the use of fomepizole and adjuvant therapies is reviewed. [cambridge.org]

Pathophysiology [2] Like the other toxic alcohols mentioned above, ethylene glycol is a parent compound that exerts most of its toxicity by conversion to metabolites. [emedicine.com]

Carefully calculate the loading dose and administration of ethanol antidote to prevent excessive administration. [emedicine.medscape.com]

The prevention of ethylene glycol metabolism is accomplished by the use of antidotes that inhibit alcohol dehydrogenase. Historically, this has been done with intoxicating doses of ethanol. [ncbi.nlm.nih.gov]