Ethylene glycol poisoning treated using combination of ethanol and haemodialysis therapy instead of fomepizole: a case report

  • Authors

    • Kazunobu Une Department of Emergency Medicine, JA Onomichi General Hospital
    • Yasumasa Kishi JA Onomichi general hospital
    • Yui Hidaka Division of Critical Care Medicine, University of Occupational and Environmental Health
    • Takashi Esaki
    2021-09-08
    https://doi.org/10.14419/ijm.v9i2.31706
  • Acute Kidney Disease, Cost Benefit, Ethylene Glycol Poisoning, Fomepizole, Haemodialysis.
  • We report a case of ethylene glycol poisoning in a 70-year-old man with headache and dysarthria. Blood tests showed a marked increase in the anion gap (29.8 mOsm/kg) and osmotic gap (14 mOsm/kg). The estimated blood concentration of ethylene glycol was 86.8 mg/dL. Ethanol was administered and he underwent haemodialysis for 7 cycles, which was discontinued on day 12. Fomepizole, which competes with alcohol dehydrogenase, is an effective treatment for ethylene glycol poisoning. However, it is usually prescribed within 24 h after poisoning, and studies on its use in cases of severe acute renal injury over time are limited. We were able to obtain good results with haemodialysis without using fomepizole. Conventional treatments such as haemodialysis may be more useful than fomepizole in terms of cost benefits in patients with addiction who have been taking the drug for a long time or who have advanced renal injury.

     

     

     


  • References

    1. [1] Amano K, Morita M, Ebihara T, Kato F, Kawada M, Usui A & Nakata Y (2018) Fomepizole for ethylene glycol poisoning: two case reviews. Nihon Kyukyu Igakukai Zasshi 29, 12-17 (in Japanese).

      [2] Basnayake BMDB, Wazil AWM, Nanayakkara N, Mahanama RMBSS, Premathilake PNS & Galkaduwa KKMCDK (2019) Ethylene glycol intoxication following brake fluid ingestion complicated with unilateral facial nerve palsy: a case report. Journal of Medical Case Reports 13, 1-4. https://doi.org/10.1186/s13256-019-2139-z.

      [3] Hovda KE & Jacobsen D (2008) Expert opinion: fomepizole may ameliorate the need for hemodialysis in methanol poisoning. Human and Experimental Toxicology 27, 539-546. https://doi.org/10.1177/0960327108095992.

      [4] Howard PH, Boethling RS, Jarvis WF, Meylan WM & Michalenko EM (1991) Handbook of environmental degradation rates. 1st edn. Lewis Publishers, Chelsea, pp. 392-393. https://doi.org/10.1201/9780203719329-3.

      [5] Kiyota K (2016) Antidote updates. Nippon Rinsho 74, 236-240 (in Japanese, abstract in English).

      [6] Ono Y, Hata N, Sonoda Y & Tohma Y (2017) Fomepizole alone therapy for a case of methanol intoxication. Nihon Kyukyu Igakukai Zasshi 28, 275-280 (in Japanese).

      [7] Mégarbane B (2010) Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole. Open Access Emergency Medicine 24, 67-75. https://doi.org/10.2147/OAEM.S5346.

      [8] Nosaka H & Satou K (2019) A case of severe ethylene glycol poisoning that was successfully treated with early administration of fomepizole and continuous renal replacement therapy. Nihon Toseki Igakkai Zasshi 52, 291-293 (in Japanese, abstract in English). https://doi.org/10.4009/jsdt.52.291.

      [9] Rietjens SJ, de Lange DW & Meulenbelt J (2014) Ethylene glycol or methanol intoxication: which antidote should be used, fomepizole or ethanol? Netherlands Journal of Medicine 72, 73-79.

      [10] Roberts DM, Yates C, Megarbane B, Winchester JF, Maclaren R, Gosselin S, Nolin TD, Lavergne V, Hoffman RS, Ghannoum M & EXTRIP Work Group (2015) Recommendations for the role of extracorporeal treatments in the management of acute methanol poisoning: a systematic review and consensus statement. Critical Care Medicine 43, 461-472. https://doi.org/10.1097/CCM.0000000000000708.

      [11] Sidlak AM, Marino RT, Van Meerbeke JP & Pizon AF (2021) Single versus continued dosing of fomepizole during hemodialysis in ethylene glycol toxicity. Clinical Toxicology 59, 106-110. https://doi.org/10.1080/15563650.2020.1770780.

      [12] Tanasescu A, Macovel RA & Tudosie MS (2014) Outcome of patients in acute poisoning with ethylene glycol-factors which may have influence on evolution. Journal of Medicine and Life 7, 81-86.

      [13] Uchida H, Hashimoto T, Owada M, Sugawara T, Kawamura M & Miyate Y (2011) Usefulness of osmolar gap in early diagnosis of case of ethylene glycol poisoning. Medical Journal of Iwate Prefectural Hospital 51, 29-32.

      [14] Yamada T & Nishio Y (2004) A case of ethylene glycol poisoning with severe metabolic acidosis and acute renal failure; successful treatment with continuous hemodiafiltration, hemodialysis and ethanol. Nihon Toseki Igakkai Zasshi 37, 169-173. https://doi.org/10.4009/jsdt.37.169.

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  • How to Cite

    Une, K., Kishi, Y., Hidaka, Y., & Esaki, T. (2021). Ethylene glycol poisoning treated using combination of ethanol and haemodialysis therapy instead of fomepizole: a case report. International Journal of Medicine, 9(2), 67-70. https://doi.org/10.14419/ijm.v9i2.31706