Citation

Ahmed A, Tschetter PA, Krasowski MD, Engelman A. J. Emerg. Med. 2014; 46(3): e69-74.

Affiliation

Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.

Copyright

(Copyright © 2014, Elsevier Publishing)

DOI

10.1016/j.jemermed.2013.08.068

PMID

24199725

Abstract

BACKGROUND: Ethylene glycol is a toxic organic solvent implicated in thousands of accidental and intentional poisonings each year. Osmotic demyelination syndrome (ODS) is traditionally known as a complication of the rapid correction of hyponatremia. OBJECTIVE: Our aim was to describe how patients with ethylene glycol toxicity may be at risk for developing ODS in the absence of hyponatremia. CASE REPORT: A 64-year old female patient was comatose upon presentation and laboratory results revealed an anion gap of 39, a plasma sodium of 150 mEq/L, a plasma potassium of 3.5 mEq/L, an osmolal gap of 218, an arterial blood gas pH of 7.02, whole blood lactate of 32 mEq/L, no measurable blood ethanol, and a plasma ethylene glycol concentration of 1055.5 mg/dL. The patient was treated for ethylene glycol poisoning with fomepizole and hemodialysis. Despite having elevated serum sodium levels, the patient's hospital course was complicated by ODS. CONCLUSIONS: Rapid changes in serum osmolality from ethylene glycol toxicity or its subsequent treatment can cause ODS independent of serum sodium levels.

Language: en