Abstract
Ethylene glycol is one of the most common toxic alcohol ingestions requiring hemodialysis for treatment. With the FDA approval in 1997 of fomepizole (4-methylpyrazole), the indications for hemodialysis in addition to fomepizole for ethylene glycol poisoning have been examined in recent articles and case reports. Fomepizole, a competitive inhibitor of alcohol dehydrogenase, binds to the same site on the enzyme as ethanol, however the pharmacokinetics of fomepizole are more predictable, and with fewer side effects compared to ethanol. Current guidelines cited in the literature for the use of hemodialysis in ethylene glycol poisoning include patients with severe metabolic acidosis (pH 7.3), serum ethylene glycol level 50 mg/dL, acute kidney injury, and deteriorating vital signs despite intensive care. This article is a review of the current literature with regard to the use of fomepizole as monotherapy for ethylene glycol poisoning, as well as the indications for hemodialysis in ethylene glycol poisoning.
Highlights
Ethylene glycol is present in many common substances such as antifreeze, de-icing substances, detergents, lacquers, and polishes [1]
Most researchers agree that if a patient with a high serum ethylene glycol (EG) level is to be treated with fomepizole alone, acid-base status should be monitored closely and HD be instituted if metabolic acidosis develops [3]
From 1985 to 2005, cases of poisoning requiring HD increased to 707 per million calls to poison control centers from 231 per million, with lithium and EG being the most common toxins removed by HD over this period [7]
Summary
Ethylene glycol is present in many common substances such as antifreeze, de-icing substances, detergents, lacquers, and polishes [1]. The dihydrate form requires a higher concentration of oxalate to be present, and is more indicative of ethylene glycol poisoning [2]. The current literature with regard to EG poisoning suggests that in many cases, fomepizole has obviated the need for HD in patients with normal renal function and in those who are not acidodic. This is especially true for patients who present early after ingestion of EG, irrespective of the plasma EG level. Most researchers agree that if a patient with a high serum EG level is to be treated with fomepizole alone, acid-base status should be monitored closely and HD be instituted if metabolic acidosis develops [3]. There is no role for the use of activated charcoal, cathartics or gastric lavage in the treatment of EG intoxication [2]
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