In relation to Ethylene glycol poisoning
It may present with an acute ascending motor and sensory neuropathy
A normal anion gap acidosis is usually seen
Alcohol dehydrogenase catabolises the metabolism of EG into metabolites including oxalate and glycolic acid
Haemodialysis is not effective
Ethylene Glycol poisoning presents in three phases depending on timing: initially (30-60 minutes) after ingestion acute intoxication occurs. This may also result in excitatory symptoms, cerebral oedema, convulsions and coma. The second phase occurs at 12-18 hours with predominantly cardiovascular effects including dysrhythmias and cardiac failure. Profound metabolic acidosis often causes death during this phase. Phase three occurs at 2-3 days with predominantly renal failure and acute tubular necrosis due to calcium deposition. Finally, a delayed neurologic phase can occur 5-20 days post-ingestion, presenting with neurological effects including profound limb weakness, cranial nerve palsies and sensory disturbance. EG causes an increased anion gap acidosis. Other causes of a raised anion gap acidosis include lactate, toxins (ethanol, ethylene glycol, methanol, paraldehyde, aspirin, cyanide, iron, isoniazid), and ketoacidosis (diabetes, alcohol). Causes of a normal anion gap acidosis include gastrointestinal losses (diarrhea), renal loss of bicarbonate (proximal renal tubular acidosis), renal failure and hyperchloraemic acidosis. Renal replacement therapy is a very effective treatment for EG poisoning, as it corrects acid-base status and eliminates EG and some of the harmful metabolites. Fomepizole is a potent inhibitor of alcohol dehydrogenase preventing the production of toxic metabolites of EG. It is given as a loading dose 15mg/kg and then 10mg/kg every 12 hours for the next 48 hours. After which, the dose is increased to 15mg/kg 12hourly. It is continued until plasma EG levels are less than 20mg/dL.Reference: Glossop AJ, Bryden DC. Case repo: an unusual presentation of ethylene glycol poisoning. J Intensive Care Soc 2009; 10(2): 118-21
General anaesthesia