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Ethylene glycol poisoning — SCE Acute Medicine MCQ

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ModerateToxicology and OverdoseEthylene glycol poisoningSCE Acute Medicine

A 76-year-old man presents with collapse, confusion or vomiting after a possible exposure. Relevant history includes medication, recreational or environmental exposure. On assessment, toxidrome features and physiological instability are present. Investigations show antifreeze exposure, osmolar gap, high anion gap acidosis and oxalate crystals. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Give fomepizole and discuss urgent haemodialysis

The key discriminator is that antifreeze exposure, osmolar gap, high anion gap acidosis and oxalate crystals, which makes Give fomepizole and discuss urgent haemodialysis the single best answer. Call critical care for escalation is less appropriate because it does not address the dominant acute risk in the vignette; Give targeted antidote or reversal therapy would fit a different presentation or later stage of care. Give controlled oxygen and senior review and Arrange urgent CT imaging are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: TOXBASE; BNF fomepizole