MASSIVE ETHYLENE GLYCOL POISONING TRIGGERS OSMOTIC DEMYELINATION SYNDROME

作者：Ahmed Azeemuddin^*; Tschetter Paul A; Krasowski Matthew D; Engelman Amy

来源：Journal of Emergency Medicine, 2014, 46(3): E69-E74.

DOI：10.1016/j.jemermed.2013.08.068

• ethylene glycol
• fomepizole
• renal dialysis
• acidosis
• lactic
• calcium oxalate
• osmotic demyelination syndrome
• extra pontine myelinolysis

Background: 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. Objective: Our aim was to describe how patients with ethylene glycol toxicity may be at risk for developing ODS in the absence of hyponatremia. Case Report: 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. Conclusions: Rapid changes in serum osmolality from ethylene glycol toxicity or its subsequent treatment can cause ODS independent of serum sodium levels.

• 出版日期2014-3