A 25-year-old patient presents with severe abdominal pain, vomiting, and confusion after ingesting an unknown substance. Blood tests reveal metabolic acidosis and an elevated anion gap. His urine sample demonstrates the presence of needle-shaped, birefringent crystals under polarized light. Which substance has the patient likely ingested, and what is the antidote?
This patient presentation and lab evaluation is concerning for ethylene glycol. The primary antidote is fomepizole.
Fowles J, Banton M, Klapacz J, Shen H. A toxicological review of the ethylene glycol series: Commonalities and differences in toxicity and modes of action. Toxicology Letters. 2017;278:66-83. doi:10.1016/j.toxlet.2017.06.009
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