title: Massive ethylene glycol ingestion treated with fomepizole alone-a viable therapeutic option.
abstract: Fomepizole is used to treat and prevent toxicity from ethylene glycol poisoning. Treatment with fomepizole without hemodialysis in massive ethylene glycol ingestion has been rarely reported in the literature; however, published literature and practice guidelines recommend considering dialysis for ethylene glycol levels >50 mg/dL. We report a case of massive ethylene glycol ingestion resulting in the highest serum ethylene glycol concentration in a patient without ethanol co-ingestion who was treated with fomepizole and was not hemodialyzed. A 48-year-old male presented to the emergency department after reportedly ingesting >1 liter of antifreeze in an attempt at self-harm. He denied concomitant ethanol consumption. His initial presenting serum ethylene glycol level was 700 mg/dL, with normal renal function, and a metabolic acidosis with a high anion gap. One hour after presentation, he was started on intravenous fomepizole. Treatment with fomepizole continued until the patient's plasma ethylene glycol concentration was 16 mg/dL. His metabolic acidosis quickly resolved, he had no adverse reactions to the treatment, and his renal function remained normal. Ultimately, he was discharged to a psychiatric unit without sequelae. Published literature and practice guidelines suggests considering hemodialysis initiation in patients with an ethylene glycol level > 50 mg/dL. This recommendation is anecdotally, rather than evidence, based. With the potential risks inherent in hemodialysis, our case provides evidence that treatment with fomepizole without hemodialysis appears to be a viable alternative option in patients with even extremely high plasma ethylene glycol concentrations as long as their renal function is intact.
authors.affiliation: Rocky Mountain Poison and Drug Center, Denver, CO 80204, USA. jennie.buchanan3@dhha.org
authors.forename: Jennie A
authors.initials: JA
authors.lastname: Buchanan
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alhelail
authors.forename: Edward W
authors.initials: EW
authors.lastname: Cetaruk
authors.forename: Tammi H
authors.initials: TH
authors.lastname: Schaeffer
authors.forename: Robert B
authors.initials: RB
authors.lastname: Palmer
authors.forename: Ken
authors.initials: K
authors.lastname: Kulig
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Brent
mesh_terms: D000931:Antidotes / Q000008:administration & dosage / Q000627:therapeutic use*; D001774:Blood Chemical Analysis; D019855:Ethylene Glycol / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*; D000077604:Fomepizole; D006207:Half-Life; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011720:Pyrazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D013406:Suicide, Attempted
chemical_list: D000931:Antidotes; D011720:Pyrazoles; D000077604:Fomepizole; D019855:Ethylene Glycol