Ethylene glycol poisoning treated by intravenous 4-methylpyrazole.
A 19-year-old woman was admitted 45 min after ethylene glycol (EG) ingestion. The initial serum EG concentration was 1.34 g/l (21.6 mmol/l), the anion gap 14.5, and the osmolal gap 24. Renal function was preserved (serum creatinine 75.1 micromol/l). As the patient was seen soon after poisoning, before the development of metabolic acidosis, therapy with 4-methylpyrazole (4-MP) was proposed as an antidote. 4-MP was administered via the intravenous route (7 mg/kg as loading dose, followed by 3.6, 1.2, 0.6, and 0.6 mg/kg at intervals of 12 h). 4-MP alone was effective in preventing EG biotransformation to toxic metabolites (absence of metabolic acidosis and renal injury). Ethanol therapy, hemodialysis, and sodium bicarbonate administration were not required. The half-life of EG during 4-MP therapy was 11 h, with a mean EG renal clearance of 26.9 ml/min, and a total of 65.3 g EG was eliminated unchanged in the urine. 4-MP therapy was also well tolerated.
Department of Intensive Care, Cliniques Universitaires St-Luc, Brussels, Belgium. hantson@rean.ucl.ac.be
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Hantson
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Hassoun
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Mahieu
D000136:Acid-Base Equilibrium; D000328:Adult; D000931:Antidotes / Q000627:therapeutic use*; D001711:Biotransformation; D003404:Creatinine / Q000097:blood; D019855:Ethylene Glycol / Q000378:metabolism / Q000493:pharmacokinetics / Q000506:poisoning*; D005260:Female; D000077604:Fomepizole; D006801:Humans; D007262:Infusions, Intravenous; D011041:Poisoning / Q000175:diagnosis / Q000188:drug therapy; D011720:Pyrazoles / Q000627:therapeutic use*; D013997:Time Factors
D000931:Antidotes; D011720:Pyrazoles; D000077604:Fomepizole; D003404:Creatinine; D019855:Ethylene Glycol