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Ethylene Glycol Poisoning — ESENeph MCQ

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ModerateAcute Kidney InjuryEthylene Glycol PoisoningESENeph

A 45-year-old man develops AKI after ingesting ethylene glycol (antifreeze). His pH is 7.08, bicarbonate 6 mmol/L, and anion gap is 38 mmol/L. He has a high osmolal gap. Urine shows calcium oxalate crystals. What are the two key immediate treatments?

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Correct answer: B — Fomepizole (or Ethanol) and urgent haemodialysis

Ethylene glycol poisoning causes severe high anion gap metabolic acidosis (from glycolic and oxalic acid metabolites), AKI (calcium oxalate crystal deposition), and high osmolal gap. The two key treatments are: (1) Fomepizole (preferred) or IV Ethanol – both inhibit alcohol dehydrogenase, preventing metabolism of ethylene glycol to toxic metabolites; and (2) urgent haemodialysis to remove ethylene glycol and its metabolites and correct acidosis. Treatment must not be delayed. Activated charcoal is ineffective for alcohols.

Reference: NPIS 2023 – Ethylene Glycol; KDIGO 2012 – AKI