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Early dialysis in a rare case of combined toxic alcohols ingestion.
- Source :
-
CEN case reports [CEN Case Rep] 2020 Feb; Vol. 9 (1), pp. 11-14. Date of Electronic Publication: 2019 Oct 01. - Publication Year :
- 2020
-
Abstract
- Ingestion of toxic alcohols (TA) typically presents with a high anion gap (AG) metabolic acidosis, and elevated osmolar gap (OG). Hemodialysis (HD) has not been recommended in early phases of intoxication with high OG and normal AG metabolic acidosis. We describe the case of a 40-year-old male who was brought to our emergency department for reported paint thinner ingestion. He was unable to protect his airway and required intubation. Blood gas showed respiratory acidosis, an initial AG, corrected by albumin of 12.75, lactic acid 5.26 mmol/L, and an OG of 170. Patient was treated with bicarbonate drip, fomepizole and emergent HD, which improved his neurologic status. Days after his admission, alcohol levels came positive for a co-ingestion of ethylene glycol, diethylene glycol, and methanol. Most of the TA are metabolized into their toxic byproducts by the enzyme alcohol dehydrogenase (ADH). The kinetics of these alcohols will be altered when there is co-ingestion of multiple substances. Moreover, early ingestions will translate in a high OG without a high AG. False elevation of lactate can occur with the ingestion of ethylene glycol due to a cross-reaction with L-lactate oxidase in the analyzer. In our case, the administration of fomepizole followed by an early HD given the poor clinical improvement, was followed by a fast recovery of the neurological status and potentially prevented renal failure. A high index of suspicion for TA ingestion should be raised when encountering an individual with lactic acidosis, high OG, and normal AG.
- Subjects :
- Acidosis therapy
Adult
Alcohols administration & dosage
Antidotes administration & dosage
Antidotes therapeutic use
Bicarbonates administration & dosage
Bicarbonates therapeutic use
Buffers
Combined Modality Therapy methods
Eating psychology
Ethylene Glycol blood
Ethylene Glycols blood
Fomepizole administration & dosage
Fomepizole therapeutic use
Humans
Male
Methanol blood
Solvents administration & dosage
Treatment Outcome
Acidosis chemically induced
Alcohols toxicity
Renal Dialysis methods
Solvents toxicity
Subjects
Details
- Language :
- English
- ISSN :
- 2192-4449
- Volume :
- 9
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- CEN case reports
- Publication Type :
- Academic Journal
- Accession number :
- 31576499
- Full Text :
- https://doi.org/10.1007/s13730-019-00417-0