Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-14T23:14:25Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 23:14, 14 July 2020
Line 26:		Line 26:
	* Moonshine		* Moonshine

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* Decreased LOC		* Decreased LOC

Maintenance script: Imported from text file

2020-07-04T01:17:34Z

Imported from text file

New page

== Summary ==

* AGMA with osmolar gap, hypocalcemia, AKI, hematuria, and obstruction
* Osmolar gap becomes anion gap as metabolism progresses

== Pathophysiology ==

<pre class="mermaid">graph TD
eg["Ethylene glycol"] --> |Alcohol dehydrogenase|glycerald
glycerald["Glyceraldehyde"] --> |Aldehyde dehydrogenase|glycolate
glycolate["Glycolate"] --> glycox
glycox["Glycoxylate"] --> |Thiamine & pyridoxine|metabs["Less toxic metabolites"]
glycox --> oxalate
oxalate["Oxalate"] --> |Calcium|caox
caox["Calcium oxalate"]
</pre>
* Glycolate causes renal tubular damage and oxalate crystal cause urinary obstruction
* Hypocalcemia secondary to calcium oxalate formation

== Sources ==

* Antifreeze
* Windshield fluid
* Cleaners
* Fuels
* Moonshine

== Clinical Presentation ==

* Decreased LOC
* Hematuria with flank pain and oliguria
* Hypocalcemia
** Cranial nerve palsies
* Coma, seizures, tachypnea, and hypotension in late stage

== Investigations ==

* Anion gap metabolic acidosis with osmolar gap
** As metabolism progresses the initial osmolar gap is replaced by an anion gap
* Order acetaminophen and salicylate levels as well
* Lactate can be elevated, either because of lactate or because of false-positive from the ethylene glycol
* Monitor renal function, including electrolytes, extended lytes (calcium), and creatinine
* Urine microscopy for calcium oxalate crystals, which show up as needle-shaped crystals
* Monitor ECG for QTc prolongation from hypocalcemia

== Management ==

* ABCs
* NG aspiration if within 60 minutes
* Sodium bicarb if pH <7.3, with infusion to target pH ≥ 7.35
* Thiamine and pyridoxine to shunt glycoxylate metabolism toward less harmful metabolites
* Fomepizole or ethanol, which competitively inhibit alcohol dehydrogenase
** Serum ethylene glycol >3.2 mmol/L, or
** Documented toxic ingestion and an osmolar gap > 10, or
** Suspected toxic ingestion and 2 of:
*** pH < 7.3
*** Bicarb < 20
*** Gap (which one?) > 10
*** Urinary oxalate crystals
* Hemodialysis if ongoing acidosis and evidence of end-organ damage

[[Category:Toxicology]]

Ethylene glycol toxicity - Revision history

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

Maintenance script: Imported from text file