title: [Secondary hyperoxaluria and nephrocalcinosis due to ethylene glycol poisoning].
abstract: We report the case of a 3-year-old boy admitted to the pediatric emergency department for ethylene glycol poisoning. During hospitalization, he presented dysuria associated with crystalluria. Blood tests showed metabolic acidosis with an elevated anion gap. A renal ultrasound performed a few weeks later revealed bilateral medullary hyperechogenicity. Urine microscopic analysis showed the presence of weddellite crystals. Secondary nephrocalcinosis due to ethylene glycol intoxication was diagnosed. Hyperhydration and crystallization inhibition by magnesium citrate were initiated. Despite this treatment, persistent weddellite crystals and nephrocalcinosis were seen more than 2years after the intoxication. Ethylene glycol is metabolized in the liver by successive oxidations leading to its final metabolite, oxalic acid. Therefore, metabolic acidosis with an elevated anion gap is usually found following ethylene glycol intoxication. Calcium oxalate crystal deposition may occur in several organs, including the kidneys. The precipitation of calcium oxalate in renal tubules can lead to nephrocalcinosis and acute kidney injury. The long-term renal prognosis is related to chronic tubulointerstitial injury caused by nephrocalcinosis. Treatment of ethylene glycol intoxication is based on specific inhibitors of alcohol dehydrogenase and hemodialysis in the most severe forms, and should be started promptly.
authors.affiliation: Service de pédiatrie, hôpital Pellegrin-Enfants, CHU de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France.
authors.forename: C
authors.initials: C
authors.lastname: Monet
authors.forename: E
authors.initials: E
authors.lastname: Richard
authors.forename: S
authors.initials: S
authors.lastname: Missonnier
authors.forename: L
authors.initials: L
authors.lastname: Rebouissoux
authors.forename: B
authors.initials: B
authors.lastname: Llanas
authors.forename: J
authors.initials: J
authors.lastname: Harambat
mesh_terms: D000061:Accidents, Home; D000138:Acidosis / Q000139:chemically induced; D002129:Calcium Oxalate / Q000037:antagonists & inhibitors / Q000652:urine; D002675:Child, Preschool; D019343:Citric Acid / Q000627:therapeutic use; D019855:Ethylene Glycol / Q000506:poisoning*; D005440:Fluid Therapy; D005500:Follow-Up Studies; D006801:Humans; D053565:Hypercalciuria / Q000139:chemically induced; D006959:Hyperoxaluria / Q000139:chemically induced*; D008297:Male; D009397:Nephrocalcinosis / Q000139:chemically induced* / Q000000981:diagnostic imaging; D009942:Organometallic Compounds / Q000627:therapeutic use; D014463:Ultrasonography
chemical_list: D009942:Organometallic Compounds; D002129:Calcium Oxalate; D019343:Citric Acid; C016188:weddellite; D019855:Ethylene Glycol; C110422:magnesium citrate