Tox: Ethylene glycol

-antifreeze, polishes, detergents
-EG > liver > alc dehydrog > glycoaldehyde > formic acid, glyoxylic acid, oxalic acid (+thiamine or pyridoxine) > nontoxic metabolites
-lg osm gap
-high anion-gap met acidosis
-oxalic acid + ca > calcium oxalate crystals in urine
si/sx
-3 phases
1) 1-12h - cns fx; drunk, *no odor of etoh on breath
2) 12-24h - cardiopulm fx; inc bp, ht rt, resp rate, chf, resp distress, shock
3) 24-72h - renal fx; flank pain, cva tender, atn with arf
-can get tetany and inc QT int due to hypocalcemia due to caox formation
-fundoscopic exam is nl and no visual complaints (vs. methanol tox*)
-lab eval high anion gap met acid w/ high osm gap (mudpilEs)
Rx:
-IV fluids
-FSBS
-Thiamine
-nalaxone if ams
-charcoal - won't bind alcohols, but give if coingest
-pyridoxine 100 mg and thiamine 100 mg IM or IV
-Calcium replacement
-fomepazole 15 mg/kg IV load followed by 20 mg/kg q 12 hr x 4 doses; binds 8000x > ethanol for alc dehydrog, fewer SEs; begin if suspect meth poisoning; anion gap met acid and an osm gap; EG level >20; or pt requires dialysis
-ethanol 0.6 g/kg IV load followed by 0.11 g/kg/h cont infusion, or 0.15 g/kg/h in heavy drinker, adjust infusion to keep etoh level 100 to 150; cont etoh treatment until methanol level is 0 and acidosis is resolved
-oral etoh bev - gram of etoh = cc beverage x .9 x (proof/200)
-dialysis indications - sig toxicity; meth level >20; presence anion-gap met acidosis
-Labs: BUN, Cr, glc, lytes, U/A (crystals)
Dispo
-must admit ethylene glycol and methanol toxicities due to delayed onset of sx, min 12 hrs of