Acute ethylene glycol poisoning after intentional ingestion

Background: We describe a case of acute ethylene glycol poisoning following ingestion of antifreeze agent in which serum ethylene glycol and anion gap were serially measured. Patients: A 66-year old man was hospitalized after intentional ingestion of automotive antifreeze. Upon admission, vital signs, mental status, and neurological functions were normal. Initial laboratory tests revealed no serum ethanol, normal serum electrolytes, and no osmolal gap, but slightly elevated serum lactate, and a high anion gap. Interventions: The patient was admitted to the Intensive Care Unit (ICU) 3 hours after ingestion. Intravenous infusion of 10% ethanol was started without delay and continued for 48 hours. A single course of haemodialysis was performed shortly after admission. After 3 days, the patient was discharged from the hospital on his own request. Measurements and results: Toxicological analysis of blood was positive for ethylene glycol. Gas chromatographic measurements of serial serum specimens revealed a maximum ethylene glycol concentration of 1644 mg/l and an exponential decline with a half-life of t1/2 = 31 hours. Conclusion: Ethylene glycol has a slow elimination rate and a long half-life after infusion of ethanol maintaining the blood level between 1.0-1.5 ‰. The patient was dialyzed because of a metabolic acidosis and a beginning renal failure. The glycol concentration and the anion gap acidosis were effectively diminished.