Ethylene Glycol Poisoning

Signs and Symptoms:
The principal clinical features of ethylene glycol poisoning are some degree of inebriation or alternation of consciousness, a profound metabolic acidosis, and acute renal failure. In severe cases, clinical hypocalcemia, multiorgan-system failure, and death occur. Methanol poisoning can cause metabolic acidosis, visual changes that may progress to blindness, and multiorgan-system failure and death. Untreated methanol poisoning is associated with a rate of death of 28% and a rate of visual deficits or blindness of 30% in survivors.


Antidotes for Methanol or Ethylene Glycol Ingestions:
Both ethylene glycol and methanol are primarily metabolized through the hepatic enzyme alcohol dehydrogenase. Either ethanol or fomepizole (4-methylpyrazole) can be used to inhibit alcohol dehydrogenase. Fomepizole was approved in the United States for the treatment of ethylene glycol poisoning in 1997; in 2000, an indication for methanol toxicity was added. Hemodialysis is an important adjunctive therapy for any ethanol-treated patient with a serum concentration of ethylene glycol or methanol of at least 50 mg per deciliter, significant academia, renal failure, or visuals signs or symptoms. Fomepizole has obviated the need for hemodialysis in many patients.

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New England Journal of Medicine - Vol. 360, No. 21, May 21, 2009