title: Predictors of Death and Prolonged Renal Insufficiency in Ethylene Glycol Poisoning.
abstract: BACKGROUND
  We assessed the predictive value of selected factors on the outcomes of death and prolonged renal insufficiency (RI) from ethylene glycol poisoning.
  
  
  METHODS
  Retrospective, observational California Poison Control System study, over a 10-year period (1999-2008). We compared 2 groups. The first group (D/RI) included 59 patients who died (9 patients) or had prolonged RI (50 patients). Prolonged RI was defined as kidney injury in which dialysis was required for greater than 3 days after presentation. The second group (RECOV) of 62 patients had an uncomplicated recovery. Secondarily, we evaluated the association of time to antidote (ethanol and/or fomepizole) and time to dialysis with these outcomes.
  
  
  RESULTS
  The D/RI group was more likely than the RECOV group to present comatose, have seizures, and require intubation. The D/RI group had a lower mean initial arterial pH of 7.03 (standard deviation [SD] 0.20), compared to 7.27 (SD 0.14) for the RECOV group. The D/RI group had a higher initial creatinine (1.7 mg/dL, SD 0.71) than that of the RECOV group (1.0 mg/dL, SD 0.33). Patients with a time to antidote greater than 6 hours had a higher odds of dying or having prolonged RI (OR 3.34, 95% CI : 1.21-9.26) Patients with a time to dialysis greater than 6 hours had a lower odds of dying or having prolonged RI (OR 0.36, 95% CI : 0.15-0.87).
  
  
  CONCLUSIONS
  Compared to survivors with an uncomplicated recovery, patients poisoned with ethylene glycol who died or had prolonged RI were more likely to exhibit clinical signs such as coma, seizures, and acidosis. Antidote administration within 6 hours is associated with better outcomes, unlike earlier time to dialysis.
authors.affiliation: Department of Emergency Medicine, University of California, San Francisco, CA, USA California Poison Control System, San Francisco Division, University of California, San Francisco, CA, USA derrick.lung@emergency.ucsf.edu.
authors.forename: Derrick D
authors.initials: DD
authors.lastname: Lung
authors.affiliation: California Poison Control System, San Francisco Division, University of California, San Francisco, CA, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Kearney
authors.affiliation: California Poison Control System, San Francisco Division, University of California, San Francisco, CA, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Brasiel
authors.affiliation: California Poison Control System, San Francisco Division, University of California, San Francisco, CA, USA.
authors.forename: Kent R
authors.initials: KR
authors.lastname: Olson
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced / Q000401:mortality* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000931:Antidotes / Q000627:therapeutic use; D002140:California / Q000453:epidemiology; D002423:Cause of Death; D003404:Creatinine / Q000097:blood; D000431:Ethanol / Q000627:therapeutic use; D019855:Ethylene Glycol / Q000506:poisoning*; D005260:Female; D000077604:Fomepizole; D006801:Humans; D008297:Male; D008875:Middle Aged; D011720:Pyrazoles / Q000627:therapeutic use; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D061665:Time-to-Treatment; D055815:Young Adult
chemical_list: D000931:Antidotes; D011720:Pyrazoles; D000431:Ethanol; D000077604:Fomepizole; D003404:Creatinine; D019855:Ethylene Glycol
keywords: dialysis; ethylene glycol; fomepizole; mortality; renal failure