Acute ethylene glycol poisoning after intentional ingestion

Background: We describe a case of acute ethylene glycol poisoning following ingestion of antifreeze agent in which serum ethylene glycol and anion gap were serially measured. Patients: A 66-year old man was hospitalized after intentional ingestion of automotive antifreeze. Upon admis-sion, vital signs, mental status, and neurological functions were normal. Initial laboratory tests revealed no serum ethanol, normal serum electrolytes, and no osmolal gap, but slightly elevated serum lactate, and a high anion gap. Interventions: The patient was admitted to the Intensive Care Unit (ICU) 3 hours after ingestion. Intravenous infusion of 10 % ethanol was started without delay and continued for 48 hours. A single course of haemodialysis was performed shortly after admission. After 3 days, the patient was discharged from the hospital on his own request. Measurements and results: Toxicological analysis of blood was positive for ethylene glycol. Gas chroma-tographic measurements of serial serum specimens revealed a maximum ethylene glycol concentration of 1644 mg/l and an exponential decline with a half-life of t1/2 = 31 hours. Conclusion: Ethylene glycol has a slow elimination rate and a long half-life after infusion of ethanol maintaining the blood level between 1.0-1.5 ‰. The patient was dialyzed because of a metabolic acidosis and a beginning renal failure. The glycol concentration and the anion gap acidosis were effectively diminished. 1