Overview
Introduction
A person who appears drunk but has no convincing ethanol explanation may be developing a toxic alcohol emergency.
A person who appears drunk but has no convincing ethanol explanation may be developing a toxic alcohol emergency. Ethylene glycol, found in many antifreeze products, initially causes mild intoxication; after alcohol dehydrogenase begins metabolizing it, glycolate drives severe metabolic acidosis and oxalate damages the kidneys while binding circulating calcium. The diagnostic pattern changes with time, so a normal osmolar gap or a low ethylene glycol concentration cannot reassure you in a late presentation. The immediate clinical objective is to block further metabolism with fomepizole while correcting life-threatening derangements and determining whether hemodialysis is needed.