Carrasco-Nieva M, Sánchez-Villegas MC

Language: Spanish
References: 12
Page: 140-148
PDF size: 486.20 Kb.

ABSTRACT

Ethylene glycol is a colorless, odorless, sweet-tasting liquid commonly found in antifreeze, windshield wiper fluid, brake fluid, automobile transmission fluid, as well as industrial agents. It is considered one of the toxic alcohols, and is a frequent cause of intentional ingestion for acts of self-harm or accidental ingestion in the workplace and at home; affecting children and adults of different ages, regardless of social status and sex. Its toxicity is mediated by its metabolites, glycolic acid and oxalate; these metabolites can cause acute kidney disease, elevated anion GAP metabolic acidosis, and alcoholic ketoacidosis as another complication added to treatment. Diagnosis is a great challenge, since emergency services do not have the specific diagnostic test in blood, which is rarely or not available; the presence of calcium oxalate crystals in urine is usually a characteristic finding that guides the diagnosis, but is also poorly available. Ethylene glycol poisoning is only suspected or usually suggested by an elevated anion gap, metabolic acidosis, and an elevated osmolar gap in the context of accidental ingestion or injury. For its treatment, critical support care, ethanol and hemodialysis are required, the latter being little available in the emergency areas of our country. There is a specific antidote such as fomepizole or intravenous ethanol, which inhibit the enzyme alcohol dehydrogenase and thus prevent the formation of toxic metabolites, however, the cost of the specific antidote exceeds its availability or existence in emergency services. Oral ethanol can be used, which is available in distilled beverages such as vodka, tequila, and whiskey, which are more widely available and less expensive. We present the clinical case of a 79-year-old male, diabetic, with heart disease, and with accidental ingestion of ethylene glycol.

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