Childhood diethylene glycol poisoning treated with alcohol dehydrogenase inhibitor fomepizole and hemodialysis

Abstract

Diethylene glycol (DEG), a commonly used solvent, has been implicated in multiple poisoning deaths, the most recent being the Haitian acetaminophen tragedy. Unlike the more commonly seen ethylene glycol ingestion, little is understood of DEG metabolism or kinetics in humans. This has made the clinical presentation, biochemical correlates, and treatment options unclear. Patients presenting less than 12 hours after DEG ingestion may not show metabolic acidosis, whereas those presenting later may show florid metabolic acidosis. Kinetic data lend support to these observations. We report a case of DEG ingestion in a 17-month-old girl who was managed with activated charcoal, fomepizole (a recently available alcohol dehydrogenase inhibitor), and hemodialysis (HD). Pre-HD and post-HD DEG levels support clearance of DEG with HD.