Casas, R; Ruck, B; Marcus, S
Taylor & Francis Ltd., 11 New Fetter Lane London EC4P 4EE UK, [mailto:info@tandf.co.uk], [URL:http://www.tandf.co.uk]
Diethylene Glycol (DEG) is commonly found as a component in antifreeze, gas conditioning formulations, brake fluids, cosmetics, lubricants, inks, glues, dyes, packaging materials, sterno and many other products. A 50 year old male consumed 9.9 ounces of Sterno, as well as, bleach, vodka, and also used cocaine. On presentation the patient was awake and alert. He was given activated charcoal on arrival. When it was confirmed that Sterno was ingested and that it contained diethylene glycol, fomepizole was recommended. Initial labs showed a serum ethanol level of 152 mg/dl, a creatinine of 0.9 mg/dl. His pH was 7.37, pCO sub(2) was 38 torr, pO sub(2) 72 torr. He had no anion gap but had an osmolar gap of 34 (the ethanol was included in the calculation). Three hours later his pH was 7.33, pCo sub(2) of 48.9, pO sub(2) of 90. His creatinine remained at 0.9 mg/dl, his ethanol dropped to 101.4 mg/dl and his osmolar gap was 40 mOsm/kg. Due to the potential for serious outcome, dialysis was started 8 hours after the initial dose of fomepizole was given. He was dialyzed for 4 hours. His post dialysis studies showed an anion gap of 8, an osmolar gap of 8.13, and a creatinine of 0.5 mg/dl.Lab studies for toxic alcohols showed that both methanol and ethylene glycol levels were negative while the diethylene glycol level performed by gas chromatography was 150 mg/dl. Rats given fomepizole for DEG ingestion became lethargic and died, while the control group did well. One case report of a human ingesting butoxyethanol was found. In this case dialysis was performed because the patient was acidotic, fomepizole was not available and there were residual neurological deficits. Ethanol was not given because the patient was critically ill. In our case the patient did well with fomepizole and dialysis. He never became acidotic nor did his BUN or creatinine rise. Although there are a few cases in the literature regarding the separate use of dialysis or fomepizole, it appears that when confronted with DEG the use of fomepizole in conjunction with dialysis may prevent an otherwise potential acidosis and or death.