Daily bolus of LR: Ethylene glycol

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February 7, 2011 by dailybolusoflr

Ethylene glycol is a major component in radiator fluid.  It is a known toxic alcohol sometimes used in suicide attempts.
 
Most of the toxicity related to ethylene glycol is related to the metabolites.  Metabolism by alcohol and aldehyde dehydrogenase leads to glycolic acid.  Patients may develop a profound metabolic acidosis. 
 
The toxicity is classically known for the development of oxalate crystals in the urine and the precipitation of calcium oxalate crystals in blood and tissues and organs.  Precipitation in the kidney may lead to acute renal failure and patients may present with hypocalcemia.  Due to the consumption of calcium in making calcium oxalate.
 
The metabolic picture is a high anion gap metabolic acidosis with osmolar gap, although the osmolar gap may become normal as hours progress after the ingestion.
 
 
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions

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