There are different clinical signs depending on the quantity and timing of ingestion. This can be categorised into three separate phases (according to TOXBASE):
Phase 1 (30 minutes-12 hours since ingestion):
- Similar to being intoxicated with ethanol
- Nausea, vomiting, haematemesis
- Decreased consciousness
- Nystgmus, ataxia, ophthalmoplegia
- Papilloedema
- Seizures
- Metabolic acidosis
Phase 2 (12-24 hours since ingestion):
- Tachypnoea
- Sinus tachycardia
- Hypertension
- Congestive cardiac failure with pulmonary oedema
Phase 3 (24-72 hours since ingestion):
- Flank pain/renal angle tenderness
- Renal failure
- Hypocalcaemia (because calcium binds with oxalate to form crystals)
- Hyperkalaemia
- Hypomagnesaemia
Investigation findings
- Ethylene glycol level (difficult to obtain due to delays in sending to reference lab)
- High anion gap metabolic acidosis due to glycolic acid accumulation
- High osmolal gap
- The blood gas may be normal very early in the presentation. Blood lactate may be elevated because of multi-organ dysfunction, but it may also be reported as falsely high because of cross-reactivity between lactate and ethylene glycol metabolites in the blood gas analyser.
- Oxalate crystals in urine
