Ease Into Prep with a PANCE^® Question of the Day

The correct answer is B. This patient ingested ethylene glycol. This is most often found in automotive antifreeze. Characteristically, patients who have ethylene glycol ingestion appear intoxicated and develop renal failure, as evidenced by an increasing BUN and creatinine. Oxalate crystals or stones can be seen in the urine. The other mode of identification is to add fluorescein to the urine and observe for fluorescence with a Woods lamp; patients develop an anion gap metabolic acidosis, something seen in our patient. Treatment of choice is fomepizole (Antizol). Ingestion of ethanol can also be done in the setting of ethylene glycol ingestion but this puts the patient at risk for becoming inebriated. Ethanol (choice A) toxicity is diagnosed by history and checking for levels of ethanol in the blood. Treatment is generally supportive. Serious overdose of alcohol can be toxic and can be associated with mortality.

Fomepizole (Antizole) (choice C) is an alcohol dehydrogenase inhibitor that is used in the treatment of methanol and ethylene glycol ingestions. It is an alternative treatment to ethanol infusion and is used most often in the clinical setting.

Isopropyl alcohol (choice D) is diagnosed only by checking specific blood levels or by the findings of ketosis without an elevated anion gap.

Methanol toxicity (choice E) is characterized by visual disturbances that can be as severe as blindness, and by production of formic acid. This overdose condition may be associated with abdominal pain and cramping.

PEARL: Ethylene glycol toxicity causes renal failure and oxalate crystals. Methanol toxicity causes blindness. Treatment for both of these is ethanol infusion (or fomepizole).