Which indicators predict ADH failure in patients with ethylene glycol poisoning treated without extracorporeal treatment?
In a recent systematic review by Beaulieu J et al., 96 articles yielding 411 cases, the ethylene glycol dose, adverse outcomes and treatment failures from EG poisoning were mostly described in the presence of severe acidemia and/or AKI. The authors conclude that this systematic review suggests fomepizole monotherapy, without extracorporeal treatment, is an effective and safe treatment in patients with modest AKI and/or acidemia (anion gap < 28 mmol/L) regardless of the ethylene glycol concentration. These factors do not apply to ethanol monotherapy as there were more failures reported especially at higher ethylene glycol concentrations.
Beaulieu J et al. Treating ethylene glycol poisoning with alcohol dehydrogenase inhibition, but without extracorporeal treatments: a systematic review. Clin Tox 2022; 60:7, 784-797. https://doi.org/10.1080/15563650.2022.2049810