Early and late presentations of ethylene glycol poisoning.

摘要

Ethylene glycol intoxication is uncommon, but can result in life-threatening metabolic acidosis, kidney failure, and death. Diagnosing such poisoning can be problematic in the absence of a clear history of ingestion, especially in patients who present with altered mental status or those who deny such consumption. Increased osmolal gap with a detectable serum ethylene glycol level is characteristic in patients presenting soon after ingestion, but increased anion gap metabolic acidosis without osmolal gap is seen in those who present late. Prompt institution of appropriate treatment can reduce the mortality and morbidity of poisoned patients, but requires clinicians to recognize these characteristic biochemical features according to whether presentation to the hospital is early or late after ethylene glycol ingestion. In cases of unexplained kidney failure, kidney biopsy may prompt the diagnosis by showing intratubular and intracellular calcium oxalate crystal deposition. We report 2 cases of ethylene glycol-induced acute kidney injury (AKI) with the diagnosis made after kidney biopsy. We discuss differences in laboratory results observed in these 2 patients because of timing of ingestion and coingestion of ethanol. We also review the toxic kinetics and clinical manifestations of ethylene glycol poisoning.