Ahmed Moeed, Janikowski Cliff, Huda Syed, Ahmad Aiza, Morrow Lee
Internal Medicine, Creighton University School of Medicine, Omaha, USA.
Pulmonary and Critical Care Medicine, Creighton University School of Medicine, Omaha, USA.
Cureus. 2020 Dec 6;12(12):e11937. doi: 10.7759/cureus.11937.
Ethylene glycol is a colorless, odorless, sweet-tasting liquid commonly found in antifreeze, as well as in industrial agents. It is regarded as one of the toxic alcohols. Ethylene glycol poisoning usually occurs due to ingestion, and its toxicity is mediated by its metabolites, glycolic acid, and oxalate. These metabolites can cause neurological symptoms, gastrointestinal symptoms, and/or renal failure if not diagnosed and treated promptly. The diagnosis can be very challenging as the test used to detect ethylene glycol in the blood may not be readily available or due to an inaccurate history. The treatment of ethylene glycol poisoning consists of supportive care, sodium bicarbonate, and the use of an antidote (ethanol or fomepizole) which inhibits alcohol dehydrogenase and thereby prevents the formation of toxic metabolites. Patients with advanced poisonings may also require dialysis. The diagnosis is usually suggested by a high anion gap metabolic acidosis and an elevated osmolal gap in the setting of a suspected ingestion. Rarely, the osmolal gap may be close to normal which can delay the diagnosis or lead to a misdiagnosis. We report a case of ethylene glycol ingestion with a near-normal osmolal gap.
乙二醇是一种无色、无味、有甜味的液体，常见于防冻液以及工业制剂中。它被视为有毒醇类之一。乙二醇中毒通常因摄入引起，其毒性由代谢产物乙醇酸和草酸盐介导。如果不及时诊断和治疗，这些代谢产物会导致神经症状、胃肠道症状和/或肾衰竭。由于用于检测血液中乙二醇的检测方法可能不易获得，或者由于病史不准确，诊断可能极具挑战性。乙二醇中毒的治疗包括支持治疗、碳酸氢钠以及使用解毒剂（乙醇或甲吡唑），后者可抑制乙醇脱氢酶，从而防止有毒代谢产物的形成。中毒严重的患者可能还需要透析。在怀疑有摄入史的情况下，高阴离子间隙代谢性酸中毒和渗透压间隙升高通常提示诊断。极少数情况下，渗透压间隙可能接近正常，这可能会延迟诊断或导致误诊。我们报告一例渗透压间隙接近正常的乙二醇摄入病例。
