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Scientific Article | while two received fomepizole. All underwent hemodialysis. At hospital discharge, three had persistent renal insufficiency not requiring dialysis; one remained on dialysis, while seven had regained normal renal function. The average hospital stay was 8 days (range 1 to 23 days). Three patients died despite use of antidote and dialysis; all had severe metabolic encephalopathy from MTH poisoning, and death occurred after withdrawing support. Table 1 shows patient characteristics and outcomes. Discussion EG and MTH are common industrial solvents present in a wide range of solutions. These alcohols are responsible for accidental, suicidal, and epidemic poisonings. 1 In the 2004 annual report of the Toxic Exposure Surveillance System (TESS), there were 5,562 exposures with 23 deaths and 979 exposures with 4 deaths related to EG and MTH toxicity respectively in the United States (US). 1 A review of the clinical presentation, diagnosis and treatment of EG and MTH intoxication will be discussed. Ethylene glycol: Clinical Features EG is a sweet-tasting substance that is often a component of antifreeze, but can also be found in engine coolants and hydraulic brake fluids. 3 Because of its sweet taste, ability to intoxicate, and relatively low cost, it is often used as a substitute for ethanol. 3 Many authors describe three phases of EG poisoning: neurological phase, cardiopulmonary phase, and renal phase. 5 Although these stages may be concurrent, the classification offers a temporal theoretical description of EG poisoning. 5 Stage 1: Neurological (30 minutes to 12 hours after ingestion) Within minutes to several hours after EG poisoning, transient inebriation and euphoria, similar to the symptoms of ethanol intoxication, may be observed. 6 EG is a more potent CNS depressant than ethanol; the degree of obtundation for an equivalent serum level of ethylene glycol is more profound than for ethanol. 7 Nausea and vomiting can also occur due to direct irritation of the gastrointestinal tract by EG as confirmed by visualization under endoscopy as well as the appearance of focal hemorrhages in the gastric lining at autopsy. 7 As EG metabolism progresses, manifestations of central nervous system (CNS) depression, such Helping West Virginia pHysicians take the right path… …in litigation, privacy and security compliance, certificate of need, medical staff and professional disciplinary matters, credentialing concerns, complex regulatory matters and business transactions. health care practice group Ryan A. Brown Robert L. Coffield Alaina N. Crislip J. Dustin Dillard Sam Fox Michele Grinberg John D. Hoffman Amy R. Humphreys Charleston Justin D. Jack Richard D. Jones Edward C. Martin Mark A. Robinson Amy L. Rothman Don R. Sensabaugh, Jr. Salem C. Smith Morgantown Stephen R. Brooks Stacie D. Honaker Wheeling David S. Givens Phillip T. Glyptis Robert C. James Edward C. Martin, Responsible Attorney | tedm@fsblaw.com | www.fsblaw.com | (304) 345-0200 | (800) 416-3225 18 West Virginia Medical Journal
| Scientific Article Table 1. Patient Characteristics and Outcomes EG- Ethylene glycol(mg/dl), MTH- Methanol,(mg/dl) AG-Anion gap (meq/l) OG-Osmolar gap(mosm/l), MV (mechanical ventilation) September/October 2010 | Vol. 106 19
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