title: Massive ethylene glycol poisoning triggers osmotic demyelination syndrome.
abstract: BACKGROUND
  Ethylene glycol is a toxic organic solvent implicated in thousands of accidental and intentional poisonings each year. Osmotic demyelination syndrome (ODS) is traditionally known as a complication of the rapid correction of hyponatremia.
  
  
  OBJECTIVE
  Our aim was to describe how patients with ethylene glycol toxicity may be at risk for developing ODS in the absence of hyponatremia.
  
  
  METHODS
  A 64-year old female patient was comatose upon presentation and laboratory results revealed an anion gap of 39, a plasma sodium of 150 mEq/L, a plasma potassium of 3.5 mEq/L, an osmolal gap of 218, an arterial blood gas pH of 7.02, whole blood lactate of 32 mEq/L, no measurable blood ethanol, and a plasma ethylene glycol concentration of 1055.5 mg/dL. The patient was treated for ethylene glycol poisoning with fomepizole and hemodialysis. Despite having elevated serum sodium levels, the patient's hospital course was complicated by ODS.
  
  
  CONCLUSIONS
  Rapid changes in serum osmolality from ethylene glycol toxicity or its subsequent treatment can cause ODS independent of serum sodium levels.
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Azeemuddin
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Tschetter
authors.affiliation: Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Krasowski
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Amy
authors.initials: A
authors.lastname: Engelman
mesh_terms: D000931:Antidotes / Q000627:therapeutic use*; D019855:Ethylene Glycol / Q000506:poisoning*; D005260:Female; D000077604:Fomepizole; D006801:Humans; D008875:Middle Aged; D017590:Myelinolysis, Central Pontine / Q000139:chemically induced*; D009997:Osmotic Pressure; D011041:Poisoning / Q000628:therapy; D011720:Pyrazoles / Q000627:therapeutic use*; D006435:Renal Dialysis; D014882:Water-Electrolyte Balance
chemical_list: D000931:Antidotes; D011720:Pyrazoles; D000077604:Fomepizole; D019855:Ethylene Glycol
keywords: acidosis; calcium oxalate; ethylene glycol; extra pontine myelinolysis; fomepizole; lactic; osmotic demyelination syndrome; renal dialysis