Overview
Why This Poisoning Is Time-Critical
Antifreeze ingestion can initially resemble uncomplicated alcohol intoxication, yet the patient may be accumulating acids that will later cause cardiovascular collapse and renal...
Antifreeze ingestion can initially resemble uncomplicated alcohol intoxication, yet the patient may be accumulating acids that will later cause cardiovascular collapse and renal failure. Ethylene glycol itself produces only mild intoxication; the life-threatening injury begins when alcohol dehydrogenase converts it into glycolate and then oxalate. Fomepizole blocks that conversion, so it should be started on clinical suspicion rather than withheld while the team waits for a serum ethylene glycol concentration that may not be rapidly available in Canada. The diagnostic picture changes as metabolism proceeds. An elevated osmolal gap suggests unmetabolized ethylene glycol early; a high anion gap with severe acidosis is more typical later. Neither a normal osmolal gap nor absent urine crystals safely rules out the poisoning. The practical nursing question is therefore not simply, What is the ethylene glycol level? It is, Is this patient developing toxic metabolites, and have we stopped their formation yet?