Tuesday, May 17, 2011

CONSULT ROUNDS: Ethylene Glycol Toxicity

Role of Dialysis in Ethylene Glycol Toxicity
Key Points:
1.     Immediate dialysis should be done if the Anion Gap is significantly increased and there is evidence of acute renal injury
2.      Experts suggested HD in any patient with even suspected toxic alcohol ingestion with unexplained AG and osmolal gap.  Some say ph of 7.3, others ph of 7.1 to initiate dialysis
3.     If non acidemic or not in renal failure, perhaps HD can be put on hold and fomepizole can be tried. But HD can be used to clear the parent alcohol and shorten the course of the other therapies
4.     Long and good HD is needed.  Not real need to start slow. Sometimes two sessions in one day or daily HD might be needed. PD might not be that good for clearance.
5.     Continue HD till Osmolal gap closes or and ph normalizes or other renal parameters permit

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