Journal of The Korean Society of Clinical Toxicology

Original Article

A retrospective analysis of toxic alcohol poisoning: Jin Kim, Yu Jin Lee, Tae Kyu Ahn, Soo Kang; J Korean Soc Clin Toxicol. 2023;21(2):143-150. Published online December 29, 2023; DOI: https://doi.org/10.22537/jksct.2023.00014

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Abstract PDF Supplementary Material: Purpose: This study aimed to compare the clinical features of methanol and ethylene glycol poisoning.
Methods
This single-center retrospective observational study included patients with toxic alcohol poisoning who visited a regional emergency medical center. Patients with methanol and ethylene glycol poisoning from January 2004 to June 2023 were selected for the study using diagnostic codes.
Results
Twenty-two patients with toxic alcohol poisoning visited during the study period, with 11 patients for each category. Compared to methanol poisoning, ethylene glycol poisoning patients were more likely to have consumed alcohol for suicidal purposes (n=4 [36.36%] vs. n=8 [72.73%]) and were more likely to be drowsy (n=0 vs. n=6 [54.55%], p=0.016). The anion gap (25.43±8.35 mmol/L vs. 13.22±6.23 mmol/L, p=0.001) and lactic acid levels (1.785 [1.3–2.785] mmol/L vs. 9.90 [4.20–11.81] mmol/L, p=0.007) were higher in ethylene glycol poisoning patients than in methanol poisoning patients. Among alcohol dehydrogenase blockers, oral ethanol was administered to 10 patients (45.45%) (n=4 [36.36%] vs. n=6 [54.55%]), and intravenous ethanol was administered to six patients (n=4 [36.36%] vs. n=2 [18.18%]). Fomepizole was administered to two patients (9.09%) each, and renal replacement therapy was non-significantly more common in patients with ethylene glycol poisoning (n=8 [72.73%] vs. n=3 [27.27%], p=0.128). Three patients had delays in diagnosis and treatment, and while there were no fatalities, one patient was left with permanent vision damage.
Conclusion
Because these are uncommon types of poisoning and the clinical presentation is difficult to recognize early, healthcare providers should be familiar with toxic alcohol types and screen for them to ensure proper diagnosis and treatment.

Fomepizole for Ethylene Glycol or Methanol Poisoning in Children: Ha Na Min, Yoon Jung Hwang, Dong Ryul Ko, Young Seon Joo, Tae Young Kong, Min Hong Choa, In Cheol Park, Sung Phil Chung; J Korean Soc Clin Toxicol. 2017;15(2):79-85. Published online December 31, 2017; DOI: https://doi.org/10.22537/jksct.2017.15.2.79

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Abstract PDF: Purpose: The purpose of this study is to evaluate the effectiveness and adverse effect of fomepizole in the management of acute ethylene glycol or methanol poisoning in children. Methods: Databases such as PubMed, Embase, Cochrane library, and KoreaMed were searched using terms related to fomepizole, ethylene glycol, methanol and pediatric. All studies, regardless of study design, reporting effectiveness or safety endpoints in children were included. Reference citations from identified publications were reviewed. Only reports written in English or Korean languages were included. The reference search was performed by two authors. Results: Twenty-two relevant literatures were finally included. They were one narrative review, 4 retrospective case series, and 17 case reports (19 cases). Case reports were classified as 5 fomepizole only, 8 fomepizole with other therapies, and 6 no fomepizole. All patients from the literatures were fully recovered without long term sequelae. Adverse effects of fomepizole were reported including anaphylaxis, thrombophlebitis and nystagmus. Conclusion: There are insufficient literatures regarding fomepizole treatment in children with ethylene glycol or methanol poisoning. The benefits or harms are not clearly established based on the clinical evidences. More prospective comparative studies are required in the future.

Two Cases of Ethylene Glycol Poisoning: Jae Jin Kim, Sung Hyun Yun, Hyun Min Jung, Ji Hye Kim, Seung Baik Han, Jun Sig Kim, Jin Hui Paik; J Korean Soc Clin Toxicol. 2013;11(1):36-40. Published online June 30, 2013

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Abstract PDF: Ethylene glycol poisoning is treated mainly by alcohol dehydrogenase inhibition therapy and hemodialysis. Early recognition and initiation of treatment is important because toxic metabolites increase over time by hepatic metabolism; however, there is no confirmative diagnostic tool in our clinical setting. Therefore, diagnosis is dependent on history, high anion gap acidosis, high osmolal gap, etc.. Diagnosis and treatment are delayed in cases where history taking is not possible, such as a mental changed patient. Authors report on two cases of ethylene glycol poisoning by contrasting clinical outcomes, demonstrating the importance of early diagnosis and treatment for achievement of a good outcome.

Clinical Review of Toxic Alcohol Poisoning Cases in Korea: Nu-Ga Rhee, Sung-Phil Chung, In-Cheol Park, Kyeong-Ryong Lee, Hyun-Jin Kim, Gun-Bea Kim, Young-Soon Cho, In-Ho Kwon, Seung-Whan Kim; J Korean Soc Clin Toxicol. 2012;10(1):15-21. Published online June 30, 2012

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Abstract PDF: Purpose: Toxic alcohols are responsible for accidental and suicide motivated poisonings, resulting in death or permanent sequelae for the afflicted patients. Major therapeutic modalities in these cases include treatment with alcohol dehydrogenase inhibitors and extracorporeal elimination. There have been a number of case reports of toxic alcohol intoxication in Korea. The purpose of this study was to review the clinical characteristics of patients suffering toxic alcohol intoxication. Methods: We retrospectively reviewed the medical records of patients who presented with toxic alcohol intoxication at 8 emergency departments (ED) from Jun 2005 to Nov 2011. Patients who ingested methanol, isopropyl alcohol, ethylene glycol, and other alcohols except ethanol, were included in this study. The clinical characteristics of these patients were analyzed to include anion and osmolar gap, and estimated concentration of alcohol in the body. Results: During the study period, 21 patients were identified who had ingested toxic alcohol (methanol; 12 patients, ethylene glycol; 9 patients). At ED arrival, the mean anion gap was $18.7{pm}6.9$ and the osmolar gap was elevated in 13 patients. Oral and IV ethanol were administrated to 11 patients in order to inhibit alcohol dehydrogenase. Extracorporeal elimination procedures such as hemodialysis were performed in 9 patients. There were no fatalities, but the one patient suffered permanent blindness. Conclusion: This study found that ethylene glycol and methanol were the substances ingested which produced toxic alcohol intoxication. The patients presented with high anion gap metabolic acidosis and were typically treated with oral ethanol and hemodialysis.

Treatment of Ethylene Glycol Poisoning Patient Presented with Mental Change: Jin Hong Min, Jang Young Lee, Moon Gi Min, Sung Pil Chung, Seung Whan Kim, In Sool Yoo; J Korean Soc Clin Toxicol. 2004;2(2):129-132. Published online December 31, 2004

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Abstract PDF: Ethylene glycol poisoning can cause profound morbidity and is almost universally fatal if untreated. Central nervous system depression, pulmonary edema, and acute oligulic renal failure with crystalluria are among the most commonly encountered complication of ingestion. Ingestion of ethylene glycol may be an important contributor in patients with metabolic acidosis and subsequent renal failure. The diagnosis of ethylene glycol poisoning is based on nonspecific clinical symptoms and signs and indirect and direct laboratory measurement of ethylene glycol. As a result, diagnosis and treatment sometimes can be delayed. We describe 52-year-old man who visited to emergency department with mental change of unknown origin. The patient has high anion gap metabolic acidosis and renal failure due to ingestion of antifreeze that contained ethylene glycol. We used hemodialysis for elimination technique. The patient was discharged with minimal complication.

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