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Ethylene glycol poisoning — SCE Acute Medicine MCQ

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HardToxicology and OverdoseEthylene glycol poisoningSCE Acute Medicine

A 44-year-old man is assessed on the acute medical unit. He is confused after ingesting antifreeze. Blood gas shows severe high anion gap metabolic acidosis, calcium oxalate crystals are seen in urine and creatinine is rising. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: D — Give fomepizole and urgent specialist toxicology advice

Give fomepizole and urgent specialist toxicology advice is the best answer because ethylene glycol toxicity requires alcohol dehydrogenase blockade with urgent toxicology and renal input. Give intravenous lorazepam and protect the airway is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Oxalate nephropathy is a key clue to ethylene glycol ingestion.

Reference: Toxbase; BNF