Friday, February 23, 2007

Ethylene Glycol Toxicity

A 38-year-old man presented to the emergency department after reportedly ingesting antifreeze. He appeared to be intoxicated and was agitated and combative; chemical sedation was induced. Initial laboratory studies revealed a pH of 7.0, an anion gap of 22 mmol per liter, and an osmolar gap of 79 mOsm. It was noted that the patient's urine fluoresced under ultraviolet light (in the basin on the left), as compared with a negative control (in the basin on the right), which shows the purple reflection of the ultraviolet light (arrow). The patient received fomepizole, thiamine, folate, pyridoxine, and bicarbonate; he subsequently underwent hemodialysis. Laboratory studies revealed that his ethylene glycol level had been 222 mg per deciliter when the treatment began. His recovery was uneventful.
Fluorescein is a fluorescent dye added to antifreeze preparations to aid in the detection of radiator leaks. In addition to the history and elevated osmolar and anion gaps, the fluorescence of urine under ultraviolet light may aid in the early identification of ethylene glycol poisoning. False negative and false positive results may occur. For example, many containers, such as urine collection bags, may be characterized by native fluorescence.

NEJM 356;6
February 8, 2007


I would like to take this opportunity to welcome you all to the Saint Louis University Hospital, Department of Internal Medicine, Residency Program blog.
The objective of this site is to establish another mode of communication among the residents and possibly between faculty and residents. Anything (w/in reason) is open for discussion. Topics may range from upcoming social events to updates on diagnosis and therapeutics. You may even share an interesting story or experience on the wards!

Whatever your thoughts, someone will be listening!

Thank you and enjoy.

Nabil Choueiri, MD
Internal Medicine Chief Resident
Saint Louis University Health Sciences Center