علاج تسمم الإيثيلين غليكول مع تركيز البلازما الموثق >20 ملغ/ديسيلتر أو ارتفاع فجوة الأوسمول

DOI: 10.1081/clt-100102445

• Documented plasma ethylene glycol concentration >20 mg/dL.
• Documented recent (hours) history of ingesting toxic amounts of ethylene glycol and osmol gap >10 mosm/L.
• History or strong clinical suspicion of ethylene glycol poisoning and at least two of the following criteria: A. Arterial pH <7.3. B. Serum bicarbonate <20 mEq/L. C. Osmol gap >10 mosm/L. D. Urinary oxalate crystals present.
• The administration of fomepizole to patients with ethylene glycol poisoning is preferred to the use of ethanol in the following situations: ingestion of multiple substances with CNS depressant activity; any alteration of consciousness; the lack of intensive care beds; critically ill patient with an anion gap–metabolic acidosis of unknown etiology and potential exposure to ethylene glycol; the lack of laboratory support to monitor ethanol administration; and the presence of contraindications to the use of ethanol.
• Fomepizole should not be administered to patients with known hypersensitivity reactions to fomepizole or to other pyrazole compounds.
• Consider gastric aspiration and lavage if <1 h after ingestion.
• Activated charcoal if mixed ingestion.
• Correct pH <7.3 with intravenous bicarbonate.