Management

If the patient is seen within 1 to 2 h of ingestion, gastric aspiration and lavage should be considered. Activated charcoal is of no value.

Bicarbonate should be given as in methanol poisoning. Rapid correction of the acidosis by bicarbonate in these patients may provoke tetanic signs, particularly when hypocalcemia is already present (see later). Ethanol or 4-methylpyrazole (see below) is given to inhibit ethylene glycol metabolism (ethanol dose as for methanol poisoning). Hemodialysis removes ethylene glycol and glycolate and helps to correct metabolic acidosis. If blood ethylene glycol values are not available, hemodialysis should be performed for 8 h. Acute renal failure is a strong indication for hemodialysis as renal excretion is the dominant elimination pathway for ethylene glycol when its metabolism is blocked by ethanol.

Tetany and seizures should be treated with calcium intravenously. However, calcium should not be given for hypocalcemia per se as this may increase precipitation of calcium oxalate crystals in the tissues. If calcium gluconate or chloride is not effective, convulsions should be treated conventionally.

4-Methylpyrazole (fomepizole, Antizol) will most probably be accepted by the United States Food and Drug Administration (1997/8) as an alternative antidote to ethanol in ethylene glycol poisoning. The advantages of Antizol are better inhibition of alcohol dehydrogenase, lack of central nervous system depression, and slower elimination, particularly during hemodialysis. The dosage regimen is provided by the manufacturer.

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