Acidosis and coma after hemodialysis.
Ethylene glycol poisoning is a rare yet potentially fatal illness seen most commonly in association with ingestion by alcoholics or in suicide attempts. It is characterized by an elevated anion gap metabolic acidosis, osmolal gap, calcium oxalate crystals in the urine, and a well-defined clinical picture. Prompt treatment is crucial because effective intervention can prevent the neurologic, cardiac, pulmonary, and renal sequelae associated with ethylene glycol poisoning. Hemodialysis offers rapid clearance of ethylene glycol and its toxic metabolites. In this article, the case of a hemodialysis patient who suffered contamination of the dialysate solution with ethylene glycol, leading to altered mental status, coma, and severe anion gap metabolic acidosis, is reported. Despite prolonged dialysis and correction of the acidosis, the patient remained comatose and subsequently died.
Taylor
R
R
Division of Nephrology, University of Mississippi Medical Center, Jackson.
Bower
J
J
Salem
M M
MM
D000138:Acidosis / Q000139:chemically induced / Q000209:etiology*; D003128:Coma / Q000139:chemically induced / Q000209:etiology*; D015314:Dialysis Solutions / Q000009:adverse effects / Q000737:chemistry; D004340:Drug Contamination; D019855:Ethylene Glycol; D005026:Ethylene Glycols / Q000032:analysis; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008603:Mental Health; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*
D015314:Dialysis Solutions; D005026:Ethylene Glycols; D019855:Ethylene Glycol