Prognostic factors and treatment of severe ethylene glycol intoxication.
OBJECTIVE
Analysis of prognostic factors and treatment of a large epidemic of ethylene glycol intoxication.


METHODS
Retrospective case review comparing 16 survivors with 6 patients who died.


METHODS
Cooperative study between county hospitals, a university hospital, and a poison information centre.


METHODS
Survival review of 36 serious cases and chart review of 17 cases.


METHODS
Time to initial treatment with intravenous fluids, sodium, bicarbonate, ethanol, and dialysis.


METHODS
Clinical data at admission and blood chemistry at 0, 24, 48, and 72 h.


RESULTS
6 of 36 patients (17%) died; 11 of 17 patients whose charts were reviewed survived and 3 had chronic renal failure. All but 2 patients had acute renal failure. Neither delay to admission, intravenous dialysis, HCO3 or alcohol was related to outcome. At admission more patients who subsequently died had seizures, were comatose, were more acidotic, and had lower base excess and higher potassium levels than those who survived. Urine contained oxalate crystals in 10 of 14 cases. At 24 h the potassium level was higher and the base excess lower in those who died. Blood ethylene glycol levels for the patients who died and survived were no different. All survivors were dialyzed, but 2 patients who died had no dialysis. No survivor needed chronic dialysis and none had organic brain lesions.


CONCLUSIONS
In patients with severe ethylene glycol intoxication, severe acidosis, hyperkalemia, seizures, and coma at admission carry a dismal prognosis. We believe very large amounts of intravenous HCO3 should be used immediately for rapid correction of the metabolic acidosis. Intravenous ethanol and hemodialysis should be started early and continued until acidosis is corrected.
Hylander
B
B
Department of Medicine, Karolinska Hospital, Stockholm, Sweden.
Kjellstrand
C M
CM
D000138:Acidosis / Q000209:etiology / Q000628:therapy; D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D000328:Adult; D005026:Ethylene Glycols / Q000506:poisoning*; D005440:Fluid Therapy; D006801:Humans; D011041:Poisoning / Q000150:complications / Q000628:therapy; D011379:Prognosis; D012044:Regression Analysis; D006435:Renal Dialysis; D012189:Retrospective Studies
D005026:Ethylene Glycols