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Management of acute ethylene glycol poisoning
  1. Paul Wallman, Specialist Registrar,
  2. Kerstin Hogg, Clinical Research Fellow
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether methylpyrazole is better than ethanol and/or haemodialysis in the treatment of ethylene glycol poisoning. Altogether 524 papers were found using the reported search, of which none presented any evidence to answer the clinical question. Two papers reported relevant case series. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated.

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    Report by Paul Wallman,Specialist RegistrarChecked by Kerstin Hogg, Clinical Research Fellow

    Clinical scenario

    A 29 year old man attends the emergency department having ingested an unknown quantity of car anti-freeze liquid. His airway, breathing, and circulation are satisfactory. He is normoglycaemic. He appears intoxicated, has a depressed level of consciousness with no evidence of injury. You have heard that there is a new treatment available and wonder whether this (methylpyrazole) is better than the standard approach of ethanol and/or haemodialysis.

    Three part question

    In [patients poisoned with ethylene glycol] is [methylpyrazole better than ethanol with or without haemodialysis] at [preserving renal function and reducing mortality]?

    Search strategy

    Medline 1966–06/02 using the OVID interface. (exp Ethylene Glycol/ or ethylene glycol.mp OR ethylene.mp OR anti-freeze.mp OR antifreeze.mp) AND (exp ethanol or ethanol.mp OR exp Renal Dialysis/ or haemodialysis.mp OR exp pyrazoles or pyrazoles.mp OR fomepizole.mp OR methylpyrazole.mp OR exp antidotes OR antidote$.mp OR pyrazol$.mp) LIMIT to human AND English.

    Search outcome

    Altogether 524 papers were found of which only two looked at newer treatments and none were comparative. These two papers are shown in table 5.

    Table 5

    Comment(s)

    Ethylene glycol poisoning is not common and small number studies are justified. The studies shown above are observational rather than randomised trials with established practice. Furthermore in the second study 17 of 19 patients underwent haemodialysis as well as receiving fomepizole. A satisfactory randomised trial with fomepizole and “non-fomepizole” arms is needed. Both the studies shown above were supported by grants from the manufacturers of fomepizole (Antizol).

    CLINICAL BOTTOM LINE

    There is no evidence comparing the effectiveness of haemodialysis, ethanol, or fomepizole in treating ethylene glycol poisoning. Local guidance should be followed.

    Report by Paul Wallman,Specialist RegistrarChecked by Kerstin Hogg, Clinical Research Fellow

    References

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