Ethylene glycol intoxication: mind your gap(s)!—a case report

Abstract

Background: Ethylene glycol, a sweet, colorless, odorless, viscous liquid widely used in manufacturing various consumer products such as antifreeze, poses a life-threatening risk if ingested. The clinical presentation and severity of symptoms vary greatly, but high anion gap metabolic acidosis with an elevated osmol gap is suggestive of ethylene glycol intoxication. Alcohol dehydrogenase (ADH) plays a key role in the metabolization of ethylene glycol. Swift recognition and immediate treatment are vital. Case Description: We present the case of a 57-year-old man who presented with loss of consciousness along with high anion gap and osmol gap metabolic acidosis, suggesting toxic alcohol ingestion. Further work-up revealed falsely elevated lactate levels and urinary calcium oxalate crystals. An ethylene glycol level of 2,550 mg/L was measured, corresponding with a severe intoxication. Treatment included administering the antidote ethanol, hemodialysis to eliminate toxic metabolites, and supportive care. Conclusions: Ethylene glycol poisoning demands prompt medical attention. High anion gap, high osmol gap metabolic acidosis, and urinary calcium oxalate crystals are suggestive of ethylene glycol intoxication as is a lactate gap. Early intervention can significantly improve outcomes. Inhibition of ADH with ethanol can be challenging and hemodialysis might be necessary. A running ethylene glycol assay enables patient-tailored (dialysis) treatment, avoiding unnecessary costs.