Tuesday October 2, 2007
Ethanol drip in Ethylene Glycol


Q; How you write Ethanol drip in Ethylene Glycol poisoning assuming you don't have Fomepizole or Dialysis available ?


A: Ethylene Glycol poisoning is common and can have bleak outcomes. Intensivists should be aware of all the possible interventions available. Antidotal therapy is based on preventing the alcohol dehydrogenase enzyme from metabolizing ethylene glycol into toxic byproducts. In case Fomepizole or Dialysis is not available, Ethanol will competitively inhibit alcohol dehydrogenase. But the serum ethanol level must be monitored frequently.Therapeutic ethanol is administered in a bolus followed by a continuous infusion. Initially, 7.5 to 10 mL/Kg of 10% ethanol, in D5W, is administered over 30 minutes. Then, a continuous infusion of 1 to 2 mL/Kg/hr of 10% ethanol is infused until the patient has eliminated all of the EG from his serum. It is important to keep the serum ethanol level at 100 to 150 mg/dL so as to completely inhibit the alcohol dehydrogenase enzyme.

Actual antidote or first line therapy is Fomepizole (Antizol) with fewer side effects. Fomepizole blocks alcohol dehydrogenase. Fomepizole is administered as 15 mg/Kg (up to 1 Gm) initially, then 10 mg/Kg q12h times four doses, and then 15 mg/Kg q12 hours until ethylene glycol level <10>


Bonus Pearl: Fomepizole can also be use as an antidote in Methanol overdose.