According to a recent systematic review, at what ethylene glycol concentration threshold is ethanol monotherapy expected to fail?
Contrary to fomepizole, the ethylene glycol concentration appeared to predictive of ethanol failure in the cited systematic review. The authors postulate that the higher affinity and/or better efficiency of fomepizole compared to ethanol could account for the difference. At ethylene glycol concentrations above 62 mg/dL (10 mmol/L), the authors note that ethanol monotherapy alone may be insufficient to prevent complications from ethylene glycol.
1. Jessie Beaulieu, Darren M. Roberts, Sophie Gosselin, Robert S. Hoffman, Valery Lavergne, Knut Erik Hovda, Bruno Megarbane, Derrick Lung, Ruben Thanacoody & Marc Ghannoum (2022) Treating ethylene glycol poisoning with alcohol dehydrogenase inhibition, but without extracorporeal treatments: a systematic review, Clinical Toxicology, 60:7, 784-797, DOI: 10.1080/15563650.2022.2049810