Ethylene glycol poisoning requiring veno-arterial ECMO: A case report

Abstract

Supportive care is the cornerstone of the poisoned patient's treatment, waiting for eventual antidotes to act. We recently treated a case of a severe Ethylene Glycol intoxication with early-onset veno-arterial ECMO. The patient was taken to our Emergency Department with the suspicion of acute cerebrovascular accident, since he was found unconscious at home. The arterial blood gas and blood tests showed a severe metabolic acidosis with high serum lactates and creatinine levels. The cerebral Computed Tomography was negative. The rapid increase in serum lactates suggested Ethylene Glycol intoxication. Although the patient was not in shock yet, arterial and venous introducers were placed in to the femoral vessels so that when the patient showed the first signs of cardiogenic shock, veno-arterial ECMO could be initiated in a very short time. The hemodynamic state progressively improved and V-A ECMO was removed after 16 h of support with complete recovery.

Keywords: cardiogenic shock; ethilene glycol; intoxication supportive care; poisoning; veno-arterial ECMO.

Figure 1.

Sequence of arterial blood gases (ABGs), the first one at arrival in emergency department, the second one in ICU 30 min afterwards. The patient was intubated, ventilated in pressure control mode with 6 cm H₂O of positive end-expiratory pressure (PEEP), 15 cm H₂O of pressure control and 50% inspired fraction of oxygen (FiO2). Definitions: pH: acid-base balance; PaO2: partial pressure of oxygen; PaCO2: partial pressure of carbon dioxide; SpO2: oxygen saturation; Lac: lactate; BE: base excess; Na+: sodium; K+: potassium; Ca+: calcium; Bicarb: bicarbonate; AG: anion gap; Osm: serum osmolality.