Pathophys:Alcohol dehydrogenase (ADH) converts to glycolic acid, which causes acidosis and is metabolized into oxalate; this produces high osmolar gap
Lab:High osmolar gap = measured osmoles - calculated osmoles (calculated = 2 × Na + glucose/18 + BUN/2.8); r/o methanol and/or ethanol ingestion
Rx:
Ethanol po or iv continuous to levels of 100-125 mg %; to inhibit alcohol dehydrogenase
Fomepizole (Antizol) (Nejm 2009;360:2216; 1999;340:832) 15 mg/kg iv load, then 10 mg/kg q12h × 48 h, then 15 mg/kg q12h until ethylene glycol level <20 mg %; cost: $2000/rx generic; usually takes 3-4 doses
Hemodialysis especially if large ingestion, acidotic, level >50 mg %, or renal failure
Thiamine 100 mg iv + pyridoxine 2-5 gm