Internal Medicine Solution 11

Option B

Initial treatment consists of stabilizing the patient and gastric decontamination. As ethylene glycol is rapidly absorbed, gastric decontamination needs to be performed soon after ingestion to be of benefit. Gastric lavage or nasogastric aspiration of gastric contents are the most common methods employed in ethylene glycol poisoning. Ipecac-induced vomiting or activated charcoal (charcoal does not adsorb glycols) are not recommended.

Aggressive intervention should be initiated at the time of diagnosis. Intervention should consist of intravenous infusion of sodium bicarbonate to enhance renal clearance of glycolate through ion trapping; intravenous infusions of ethanol or fomepizole to block the metabolism of ethylene glycol; and hemodialysis for the removal of ethylene glycol and glycolate. Regular monitoring of the osmolar gap (corrected for ethanol level if I.V. ethanol is being used during treatment) and the anion gap will help guide therapy during hemodialysis.

Category: Medicine MCQs