[Severe ethylene glycol poisoning treated wtih fomepizole (4-methylpyrazole)]

Abstract

Background: Poisoning with ethylene glycol causes severe metabolic acidosis and renal failure, and is potentially lethal if not treated rapidly. Until recently the standard therapy for this poisoning has been bicarbonate to counteract the metabolic acidosis, inhibition of alcohol dehydrogenase (ADH) with ethanol to prevent the production of toxic metabolites and haemodialysis to remove ethylene glycol and its toxic metabolites. The new potent inhibitor of ADH, 4-methylpyrazole (fomepizole), has recently been approved for the treatment of methanol and ethylene glycol poisonings.

Material and methods: Three patients severely poisoned by ethylene glycol and treated with fomepizole are presented.

Results: Of our three patients treated with fomepizole two were managed without haemodialysis. One patient had an exceptionally high serum ethylene glycol concentration (90 mmol/l; 585 mg/dl) and was successfully treated with fomepizole without the need for haemodialysis despite pronounced metabolic acidosis.

Interpretation: Ethylene glycol poisonings may be treated effectively with fomepizole without haemodialysis.