The Service of Adult Intensive Care Medicine, The Service of Nephrology and Hypertension, The Laboratory of Clinical Chemistry, University Hospital, Lausanne, Switzerland.
Eur Rev Med Pharmacol Sci. 2021 Oct;25(20):6295-6299. doi: 10.26355/eurrev_202110_26999.
Ethylene glycol is a toxic alcohol which may induce significant toxicity when ingested accidentally or intentionally. The main clinical complications of EG poisoning include central nervous system depression, cardiorespiratory instability and renal failure, which may be lethal if improperly treated. Although the demonstration of high plasma levels of ethylene glycol confirms the intoxication, such measurements are generally not obtained in the acute setting and can be misleading due to the rapid metabolism of EG. This implies the need for alternative, indirect, diagnostic methods, which reflect the metabolic fate of EG. These include an early and transient osmolar gap, followed by an anion gap metabolic acidosis and hyperoxaluria. Another frequent finding is a lactate gap between various methods of lactate measurements. An appropriate knowledge of these laboratory findings is essential for the diagnosis of EG poisoning, and for the initiation of antidote therapy (fomepizole) and hemodialysis in selected cases. These features are illustrated by the presentation of a prototypical case of EG poisoning, in which an incomplete diagnostic workup on hospital admission resulted in an unnecessary laparotomy and a significant delay in the management of the intoxication.
乙二醇是一种有毒的醇类物质，无论是意外摄入还是故意摄入，都可能导致严重的毒性。EG 中毒的主要临床并发症包括中枢神经系统抑制、心肺功能不稳定和肾衰竭，如果处理不当，可能致命。虽然检测到血浆中乙二醇水平升高可以证实中毒，但在急性情况下通常不会进行此类检测，而且由于 EG 代谢迅速，这些检测可能会产生误导。这意味着需要替代的、间接的诊断方法，这些方法可以反映 EG 的代谢命运。这些方法包括早期和短暂的渗透压间隙，随后出现阴离子间隙代谢性酸中毒和高草酸尿症。另一个常见的发现是各种乳酸测量方法之间存在乳酸间隙。这些实验室发现对于 EG 中毒的诊断以及在某些情况下开始使用解毒剂（甲福明）和血液透析至关重要。通过展示一个典型的 EG 中毒病例来说明这些特征，在该病例中，入院时的诊断性检查不完整导致了不必要的剖腹手术，并导致中毒的处理明显延迟。
