Treatment of Ethylene Glycol Poisoning When Fomepizole Is Unavailable or Contraindicated
This protocol covers confirmed or strongly suspected ethylene glycol poisoning in patients who cannot receive fomepizole — because of documented hypersensitivity or because it is not available — and who meet one of the diagnostic thresholds below.
Clinical Scenario
- Documented plasma ethylene glycol concentration >20 mg/dL; or
- Recent history of toxic ingestion with serum osmol gap >10 mosm/L; or
- Strong clinical suspicion with at least two of: arterial pH <7.3, serum bicarbonate <20 mEq/L, osmol gap >10 mosm/L, urinary oxalate crystals
- And hypersensitivity to fomepizole, or fomepizole unavailable
Treatment Approach
The antidote approach in this setting centres on ethanol, combined with targeted concurrent supportive care. The complete sequence, monitoring parameters, and management algorithm are available in the full protocol.
Treatment Goals
Serum ethylene glycol undetectable or <20 mg/dL, patient asymptomatic, and normal arterial pH.
References
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.
- Fomepizole unavailable.
- Hypersensitivity to fomepizole.
- Ethanol therapy should continue until the ethylene glycol serum concentration is undetectable or <20 mg/dL and the patient is asymptomatic with a normal arterial pH.