PROGNOSTIC FACTORS AND TREATMENT OF SEVERE ETHYLENE-GLYCOL INTOXICATION

Objective: Analysis of prognostic factors and treatment of a large epi demic of ethylene glycol intoxication. Design: Retrospective case revi ew comparing 16 survivors with 6 patients who died. Setting: Cooperati ve study between county hospitals, a university hospital, and a poison information centre. Patients and participants: Survival review of 36 serious cases and chart review of 17 cases. Intervention: Time to init ial treatment with intravenous fluids, sodium, bicarbonate, ethanol, a nd dialysis. Measurements: Clinical data at admission and blood chemis try at 0, 24, 48, and 72 h. Results: 6 of 36 patients (17%) died; 11 o f 17 patients whose charts were reviewed survived and 3 had chronic re nal failure. All but 2 patients had acute renal failure. Neither delay to admission, intravenous dialysis, HCO3 or alcohol was related to ou tcome. At admission more patients who subsequently died had seizures, were comatose, were more acidotic, and had lower base excess and highe r potassium levels than those who survived. Urine contained oxalate cr ystals in 10 of 14 cases. At 24 h the potassium level was higher and t he base excess lower in those who died. Blood ethylene glycol levels f or the patients who died and survived were no different. All survivors were dialyzed, but 2 patients who died had no dialysis. No survivor n eeded chronic dialysis and none had organic brain lesions. Conclusion: In patients with severe ethylene glycol intoxication, severe acidosis , hyperkalemia, seizures, and coma at admission carry a dismal prognos is. We believe very large amounts of intravenous HCO3 should be used i mmediately for rapid correction of the metabolic acidosis. Intravenous ethanol and hemodialysis should be started early and continued until acidosis is corrected.