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TOX TABLES

Ethylene glycol

IMPORTANT SHIT

Osmolar gap
HAGMA (Secondary to metabolites)
Lactaemia
Ketosis
Hypocalcaemia (As Ca crystalises in urine)
AKI

Ethylene glycol level (most labs can’t do this)
U/A - Calcium Oxolate crystals

Treat if
Osmolar gap >10
pH <7.3
Bicarb <20
Urine oxolate crystals

SPECIFIC ANTIDOTE

Ethanol OR Formepizole = ADH (alcohol dehydrogenase) blockage/prevent downstream formation of toxic metabolites (Oxalic acid)
Ethanol
  • IV 10% 6 mL/kg load then 1-2 mL/kg/hr
  • PO - 4 shots vodka followed by 1 shot/hr (30 mL) - Spicy margs optional
Fomepizole
  • 15mg/kg loading
Co-Factor replacement (replace stuff used in metabolism of EG to non toxic metabolites)
  • Pyridoxime - 50 mg IV QID x48 hrs
  • Thiamine 100 mg QID x 48hr
Dialysis - eliminate Ethylene glycol/correct acidosis - start if EG level >8, osmolar gap >10, Large ingestion
  • Everything else needs dose adjustment in dialysis
Endpoints - BAL ~0.10 (if ETOH used)
HCO3 >20, osmolar gap <20, ethylene glycol level < 3.2
Self-rate:
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