Abstract
Ethylene glycol is commonly used in antifreeze, and ingestion of even a small amount can result in acute kidney injury, severe metabolic acidosis, and neurological injury. When cases are recognized early, treatment involves administration of alcohol dehydrogenase inhibitors to prevent conversion to toxic metabolites of glycolate, glyoxolate, and oxalate. In later presentations with more severe renal injury, hemodialysis may be required for clearance of toxic metabolites and supportive care for renal failure. We present the first reported case of severe ethylene glycol intoxication requiring support of extracorporeal membrane oxygenation (ECMO) due to refractory cardiopulmonary collapse.
Highlights
Ethylene glycol is present in several commonly available commercial products, notably automotive antifreeze, and cases of toxic ingestion have been reported as far back as the 1930s [1]
Treatment focuses on alcohol dehydrogenase inhibition and supportive measures for acute kidney injury (AKI) and acidosis, though in severe cases, hemodialysis may be required to facilitate clearance of both ethylene glycol and its metabolites
We report a dramatic case of ethylene glycol intoxication requiring the use of extracorporeal membrane oxygenation (ECMO)
Summary
Ethylene glycol is present in several commonly available commercial products, notably automotive antifreeze, and cases of toxic ingestion have been reported as far back as the 1930s [1]. Oxalate inflicts damage via the formation of calcium oxalate crystals that cause tubular obstruction and hypocalcemia. A peak serum concentration of 20 mg/dL is considered toxic and generally requires medical treatment, case reports describe volumes as low as 20-30 mL, approximately one mouthful of antifreeze, to have caused somnolence and acute kidney injury (AKI) requiring dialysis [4]. Treatment focuses on alcohol dehydrogenase inhibition and supportive measures for AKI and acidosis, though in severe cases, hemodialysis may be required to facilitate clearance of both ethylene glycol and its metabolites. We report a dramatic case of ethylene glycol intoxication requiring the use of extracorporeal membrane oxygenation (ECMO)
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