ETHANOL TREATMENT IN ETHYLENE-GLYCOL POISONED PATIENTS

Two otherwise healthy 16-y-old female patients were treated with sodiu m bicarbonate and ethanol after the ingestion of unknown quantities of ethylene glycol. Patient 2 was admitted twice for ethylene glycol poi soning in unrelated events. In patient 1, the maximum levels of ethyle ne glycol and glycolate in plasma were 14 mmol/L (0.9 g/L) and 8.2 mmo l/L (0.5 g/L), respectively. In patient 2, the maximum levels of ethyl ene glycol in plasma during the 2 admissions were 18 mmol/L (1.1 g/L) and 45 mmol (2.8 g/L), respectively. In patient 1, a blood ethanol con centration between 130-140 mg/dL (28-30 mmol/L) was reached 3 h after the start of ethanol administration and maintained for 22 h. During th is period, ethylene glycol metabolism was effectively inhibited as ind icated by S-glycolate levels and that 88% of the eliminated ethylene g lycol was accounted for in the urine. This suggests that ethanol thera py alone may be sufficient for patients admitted early with low serum ethylene glycol concentrations. During the admissions of patient 2, th e blood ethanol concentrations were presumed to effectively inhibit et hylene glycol metabolism as judged from normal acid/base parameters. H owever, during the second admission the bolus infusion of ethanol was associated with respiratory arrest. During both admissions for patient 2, hemodialysis constituted the major route of ethylene glycol elimin ation.