Ethylene Glycol Poisoning Using Ethanol Therapy

Ethylene glycol poisoning using ethanol therapy

Deepa. S ¹, Subathra Devi. M ², Maha Lakshmi^3*

¹Nursing Supervisor, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

²Nurse Educator, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

³Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

*Correspondence

Abstract

This article reports on a 27years old male admitted with a history of intentional coolant ingestion. On admission, the patient had altered sensorium and evidence of high anion gap metabolic acidosis with evolving renal impairment. Early recognition of toxic Ethylene Glycol poisoning was made based on clinical history and laboratory findings. The patient was managed with supportive care, correction of metabolic acidosis, antidotal therapy and close monitoring of renal and neurological status. Timely intervention resulted in gradual clinical improvement and recovery with the need for renal replacement therapy. This report highlights the importance of early diagnosis, prompt ignition of appropriate antidotal and supportive treatment and vigilant nursing management in improving outcomes in coolant poisoning.

Key words: Ethanol Therapy; Ethylene glycol (EG); Antidotal therapy

Introduction

Coolant poisoning is a life-threatening condition caused by ingestion of ethylene glycol containing anti-freeze. It leads to severe metabolic acidosis, renal failure and neurological complications if not treated early. Early recognition and prompt management are crucial to reducing morbidity and mortality.

Ethylene glycol (EG) is the main component of antifreeze. EG is a colorless, odorless, sweet tasting substance widely used in automotive coolants and industrial products.EG is metabolized into oxalic acid, formic acid, and hippuric acid in the body which can lead to acute kidney injury and nervous system inhibition. Early diagnosis is often challenging due to nonspecific symptoms making timely antidotal therapy and supportive care essential. This report highlights the clinical presentation and successful management of coolant poisoning in a young adult male.

Case presentation

A 27-year-old male, known to have Depressive Disorder on treatment, was brought to our ER with an alleged history of consumption of coolant (Ethylene glycol) approximately 200 ml on 09/12/2025, followed by complaints of 2 episodes of vomiting.

On arrival at the ER, the patient was drowsy, disoriented, and hemodynamically stable.

Screening ultrasound showed good LV contractility, collapsing IVC, and normal lung findings. Relevant investigations were sent. His ABG analysis showed severe metabolic acidosis (HAGMA) with elevated lactate levels (>20), urine ketones were positive. Nephrologist opinion was obtained and the patient was taken up for Hemodialysis. He was shifted to ICU for further care.

Investigations revealed leukocytosis, acute kidney injury. Urine analysis showed significant pus cells and presence and calcium oxalate crystals. He was managed with intravenous fluids, isotonic bicarbonate infusion, multivitamin supplements.

Social History

He does not have any social history of cigarette smoking and alcohol addiction.

Allergies

No known medicine or environmental allergies.

Past Medical History

Known to have Depressive disorder on regular treatment.

Past Surgical history

No past surgical history.

Physical Examinations

The patient was drowsy but arousable.

Vitals

PR	83b/min
BP	120/70mmHg
Temp	97.4'F
SpO2	97% on room air
RR	20 br/min
GCS	E4 V4 M6
GRBS	99 mg /dl
CVS	S1S2 (+)
RS	B/L AE (+)
P/A	Soft
CNS	NFND

Screening ultrasound

Good LV contractility.

Collapsing IVC.

Normal lung findings.

Markable Investigation

S No	Investigation Name	Result
1	Procalcitonin	1.17 ng/mL
2	Chloride Blood	108 mEq/L
3	HCO3(c)	7.5 mmol/L to 28.5 mmol/L
4	pH Blood	7.23 NA to 7.39NA
5	PCO2	18 mm Hg to 47 mm Hg
6	Glucose	96 mg/dL to 135mg/dl
7	Lac	20.0 mmol/L to 0.6mmol/L
8	K +	4.5 mmol/L
9	NA+	144 mmol/L
10	Total Bilirubin	0.55 mg/dL
11	Indirect Bilirubin	0.32 mg/dL
12	Direct Bilirubin	0.23 mg/dL
13	Creatinine	1.37 mg/dL
14	Urea	21.40 mg/dLto19.26 mg/dL
15	Total WBC Count	25540 Cells/Cumm to 10220 Cells/Cumm
16	Alcohol (Ethanol) Screen	<5.0mg/dl

Chest X-Ray

Management and Treatment

The patient was immediately shifted to ICU for close monitoring. Nasogastric tube infusion of Ethanol therapy was initiated using wine as an antidote under strict medical supervision (ethanol (40%) mixed 5%DNS solution).

His ABG analysis showed severe metabolic acidosis (HAGMA) with elevated lactate levels (>20), urine ketones were positive. Nephrologist opinion was obtained and the patient was taken up for Hemodialysis.

Investigations revealed leukocytosis, acute kidney injury. Urine analysis showed significant pus cells presence and calcium oxalate crystals. He was managed with intravenous fluids, isotonic bicarbonate infusion, multivitamin supplements, intravenous empirical antibiotics and dyselectrolytemia was corrected appropriately and his sensorium improved. SLED done twice during the course in ICU. Serial Blood Gas analysis showed resolving acidosis

Psychiatrist opinion was obtained. The patient was shifted to a ward with stable hemodynamic. Patients had low grade fever spikes in the ward, both cultures were sterile. Repeated blood investigations show resolving AKI and thrombocytopenia. The patient’s overall clinical condition and lab parameters were improved.

Nursing Management

Nursing management played a crucial role in the successful outcome of this patient with the coolant poisoning. Continuous assessment, early detection of complications and supportive care were essential throughout the treatment period.

Initial Assessment and Monitoring

Conducted rapid assessment of airway breathing and circulation.
Monitored vital signs hourly.
Assessed level of consciousness hourly.
Observed the signs of central nervous system depression such as drowsiness, confusion and seizures.

Airway and Breathing Management

Ensured airway patency and positioned the patient to prevent aspiration.
Monitored respiratory pattern for Kussmaul breathing due to metabolic acidosis.
Prepared for ventilator support if respiratory compromise developed.

Circulatory Support and Fluid Management

Established and maintained intravenous access.
Administered intravenous fluids as ordered to maintain adequate hydration.
Monitored blood pressure for hypotension.
Maintained strict intake and hourly output output chart.

Antidotal Therapy (Ethanol administered as wine)

Administered Ethanol therapy in the form of wine as prescribed.
Closely monitored for adverse effects such as sedation, nausea, vomiting and hypoglycemia.
Assessed blood glucose levels at regular intervals.
Ensured patient safety due to altered sensorium during ethanol therapy.
Documented time dose route and patient response accurately.

Management of Metabolic Acidosis

Monitored arterial blood gas values regularly.
Administered sodium bicarbonate infusion as prescribed.
Observed for improvement in respiratory pattern and acid base balance.
Reported abnormal laboratory findings promptly.

Renal Function Monitoring and Dialysis Care

Monitored renal parameters including serum creatinine urea and electrolytes.
Observed for Oliguria or anuria.
Prepared the patient for haemodialysis.
Maintain strict aseptic technique during Dialysis.
Monitored for complications related to dialysis such as hypotension and infection.

Electrolyte and Laboratory Monitoring

Monitored serum electrolytes especially sodium potassium and calcium.
Observed the signs of electrolyte imbalance such as muscle weakness or arrhythmias.
Ensured timely collection and reporting of lab values.

Neurological Observation

Performed frequent neurological assessments.
Monitored for seizure or worsening mental status.
Ensured a calm and safe environment to prevent injury.

Infection prevention

Followed a strict aseptic technique during all invasive procedures.
Provided regular oral care and skin care.
Monitored insertion site for signs of infection.

Psychological Support and Counselling

Provided emotional support to the patient and family.
Encouraged expression of feelings and concerns.
Coordinated psychiatric evaluation and counselling prior to discharge.
Emphasized the importance of follow up and mental health support.

Diagnosis

Ethylene glycol toxicity
AKI (resolving)

Condition at Discharge

General Condition good.

Vitals stable.

Discharge Medications

S. No	Drugs Name	Strength	Frequency	Route	Days
1	Tab. Taxim o	200 MG	BD	Oral	5 days
2	Tab. Nefrosave	-	BD	Oral	5 days
3	Tab. Nodosis	-	BD	Oral	5 days
5	Tab. Pan	40 MG	BD	Oral	5 days

Discussion

Ethylene glycol poisoning often presents nonspecific early symptoms, making diagnosis challenging. The toxic metabolites are responsible for severe metabolic acidosis and renal damage. Ethanol therapy remains an effective and economical antidote in resource-limited settings. Hemodialysis plays a vital role in removing glycol ethylene and its metabolites. This case emphasizes the importance of early detection antidotal therapy and comprehensive nursing care in improving patient outcomes.

Conclusion

Coolant poisoning is a medical emergency with potentially fatal consequences if untreated. Early diagnosis, prompt initiation of antidotal therapy, correction of metabolic abnormalities and vigilant nursing care are essential for patient survival. Early multidisciplinary care and patient education contribute to favorable outcomes.

Ethylene Glycol Poisoning Using Ethanol Therapy

Ethylene glycol poisoning using ethanol therapy

Deepa. S 1, Subathra Devi. M 2, Maha Lakshmi3*

Nightingale Journals

Deepa. S ¹, Subathra Devi. M ², Maha Lakshmi^3*