Massive Ethylene Glycol Poisoning Triggers Osmotic Demyelination Syndrome

Azeemuddin Ahmed; Paul A Tschetter; Matthew D Krasowski; Amy Engelman

doi:10.1016/j.jemermed.2013.08.068

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Massive Ethylene Glycol Poisoning Triggers Osmotic Demyelination Syndrome

Journal article

Peer reviewed

Massive Ethylene Glycol Poisoning Triggers Osmotic Demyelination Syndrome

Azeemuddin Ahmed, Paul A Tschetter, Matthew D Krasowski and Amy Engelman

The Journal of emergency medicine, Vol.46(3), pp.e69-e74

03/2014

DOI: 10.1016/j.jemermed.2013.08.068

PMID: 24199725

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Abstract

Ethylene glycol is a toxic organic solvent implicated in thousands of accidental and intentional poisonings each year. Osmotic demyelination syndrome (ODS) is traditionally known as a complication of the rapid correction of hyponatremia. Our aim was to describe how patients with ethylene glycol toxicity may be at risk for developing ODS in the absence of hyponatremia. A 64-year old female patient was comatose upon presentation and laboratory results revealed an anion gap of 39, a plasma sodium of 150 mEq/L, a plasma potassium of 3.5 mEq/L, an osmolal gap of 218, an arterial blood gas pH of 7.02, whole blood lactate of 32 mEq/L, no measurable blood ethanol, and a plasma ethylene glycol concentration of 1055.5 mg/dL. The patient was treated for ethylene glycol poisoning with fomepizole and hemodialysis. Despite having elevated serum sodium levels, the patient's hospital course was complicated by ODS. Rapid changes in serum osmolality from ethylene glycol toxicity or its subsequent treatment can cause ODS independent of serum sodium levels.

lactic

extra pontine myelinolysis

osmotic demyelination syndrome

ethylene glycol

acidosis

fomepizole

calcium oxalate

renal dialysis

Details

Title: Subtitle: Massive Ethylene Glycol Poisoning Triggers Osmotic Demyelination Syndrome
Creators: Azeemuddin Ahmed - Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Paul A Tschetter - Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Matthew D Krasowski - Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa
Amy Engelman - Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Resource Type: Journal article
Publication Details: The Journal of emergency medicine, Vol.46(3), pp.e69-e74
DOI: 10.1016/j.jemermed.2013.08.068
PMID: 24199725
NLM abbreviation: J Emerg Med
ISSN: 0736-4679
eISSN: 2352-5029
Publisher: Elsevier Inc
Language: English
Date published: 03/2014
Academic Unit: Management and Entrepreneurship ; Pathology; Emergency Medicine
Record Identifier: 9984024530402771

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