Treatment of Severe Pediatric Ethylene Glycol Intoxication with Fomepizole Alone

• Main Authors: Murphy, NG, Sonier, T, Power, D, Bona, DR
• Format: Conference Proceeding
• Language: English
• ISSN: 1556-3650

Background: Fomepizole is routinely used in the treatment of ethylene glycol (EG) toxicity and may obviate the need for hemodialysis in selected cases. Recently, an EG level of >50 mg/dl (8 mmol/L) as an independent criterion for hemodialysis has been challenged. Clinical criteria, such as acid-base status, renal function, and hemodynamics, are more relevant in determining the need for hemodialysis. This is of particular significance in the pediatric population, for whom such invasive procedures are even less desirable than in adults. There is a paucity of published supporting data for this approach. We report a case of a large pediatric EG ingestion treated with fomepizole alone. Case Report: A 15 year-old male presented to the emergency department 90 minutes after intentional ingestion of-500 mls of EG. The patient appeared mildly inebriated and vital signs were normal except for sinus tachycardia. Initial blood chemistry was normal with a venous pH of 7.35, HCO3 21.3, creatinine 1.1 mg/dL (95 umol/L) and an anion gap of 15.7. Peak EG level was 459 mg/dl (74mmol/L) and ethanol level was negative. Within 10 minutes of arrival, fomepizole was administered as per protocol. During hospital admission, acid-base status and blood chemistry remained within normal limits. No complications relating to renal dysfunction or hyperosmolar state developed. No adverse event from fomepizole was recorded. The patient was discharged 78 hours post ingestion with a negative EG level. Case Discussion: Due to the early presentation and rapid treatment with fomepizole, our patient did not develop any complications from the EG ingestion. To our knowledge, this patient had the highest published EG level in a pediatric case. The management and outcome of this case reinforces the general consensus that, in selected cases, fomepizole may reduce the need for hemodialysis, even in the context of extremely elevated EG levels. Conclusion: Avoidance of invasive procedures, such as hemodialysis, is especially important in the pediatric population. We report a case of successful treatment of intentional pediatric ingestion of EG with fomepizole alone, despite the high EG level of 459 mg/dL.