What is the management of ethylene glycol ingestion?
Consult TOXBASE for detailed management
ABCDE assessment
Consider gastric aspiration/lavage if within 1 hour of life-threatening dose and the airway is protected
Antidotes: fomepizole or ethanol if there is a delay in sourcing fomepizole (these minimise further metabolism of ethylene glycol): TOXBASE recommends administration if suspected >10g ingestion within the last 12 hours or if osmolal gap >10mOsm/kg or high anion gap metabolic acidosis with no other likely cause; continue the antidotes until plasma ethylene glycol concentration <50 mg/L (<0.8 mmol/L)
Metabolic acidosis: consider sodium bicarbonate if persisting acidosis despite correction of any hypoxia and optimal fluid balance
Renal replacement therapy should be considered if there is severe metabolic acidosis, renal failure, worsening clinical picture despite optimal supportive management or severe electrolyte disturbance; haemodialysis is much more effective than haemofiltration for the clearance of ethylene glycol and its metabolites
Other supportive management including magnesium replacement if low, however not replacing calcium if hypocalcaemia unless QT interval > 500ms or there are persistent convulsions (because of the risk of worsening calcium oxalate crystal formation when calcium is administered)
