Comment on treatment methods for ethylene glycol intoxication.

S E P T E M B E R 2 0 1 4 , V O L . 7 2 , N O 7 © Van Zuiden Communications B.V. All rights reserved. To the Editor, We were very interested in the article by Rietjens et al. regarding antidotal therapies utilised in the treatment of ethylene glycol and methanol intoxication. We were especially interested in the cost analysis of ethanol versus fomepizole treatment. In the United States (US), the use of ethanol is rare; either fomepizole or haemodialysis is utilised, with cost often the determining factor in deciding which to use. At our facility we utilise a cost minimisation method for determining when to use haemodialysis versus fomepizole in minimally symptomatic patients. As an example, assume a theoretical patient: an 18-year-old male, 173 cm, weighing 70 kg. A 14.2 hour half-life for ethylene glycol following administration of fomepizole is assumed and this formula, developed by Hirsch, et al. to determine required dialysis time for removal of ethylene glycol to a serum level of 6 mmol/l (37.2 mg/dl) is used: