An 8-year-old boy is brought to the emergency room by paramedics with a reported ingestion about four hours ago. The patient had an accidental ingestion of "antifreeze" after mistaking it for a beverage in the garage.
Which of the following is the most appropriate treatment of early ethylene glycol ingestion?

Question

An 8-year-old boy is brought to the emergency room by paramedics with a reported ingestion about four hours ago. The patient had an accidental ingestion of "antifreeze" after mistaking it for a beverage in the garage.
Which of the following is the most appropriate treatment of early ethylene glycol ingestion?

Quizplus · Accepted Answer

Explanation: Early and prompt treatment of ethylene glycol ingestion is required to prevent permanent tissue damage and death. Ethylene glycol gets metabolized in the body by an enzyme, alcohol dehydrogenase (ADH), into a variety of toxic metabolites, including glycolic acid, glyoxylic acid, and oxalic acid. Fomepizole is a competitive inhibitor of ADH, and is the antidote of choice in cases of ethylene glycol intoxication (and also methanol intoxication). If used early, it prevents the formation of toxic metabolites, causes a dramatic improvement in acidemia, and prevents renal failure. It also prolongs the half-life of ethanol; therefore, simultaneous use with ethanol is not recommended (Choices C, D, and E). (Choice A) Ethanol can also be used for the treatment of patients with methanol or ethylene glycol intoxication. Alcohol dehydrogenase actually has a greater affinity for ethanol than the other alcohols; however, fomepizole inhibits ADH more potently than ethanol and is, therefore, the antidote of choice. Educational Objective: Fomepizole is the antidote of choice in cases of ethylene glycol and methanol intoxication. Simultaneous use with ethanol is not recommended.

An 8-Year-Old Boy Is Brought to the Emergency Room by Paramedics