A 2 year old boy presents with fever for 3 days which responded to administration of paracetamol. Three days later he developed acute renal failure, marked acidosis and encephalopathy? His urine showed plenty of oxalate crystals. The blood anion gap and osmolal gap were increased. Which of the following is the most likely diagnosis -
Ans. is 'b' i.e., Diethyl glycol poisoning It is case of Ethylene glycol poisoning.The key to the diagnosis of Ethylene glycol poisoning is recognition of-Anion gap acidosisIncreased osmolar gapIncreased oxalate crystals in urine Ethylene glycol poisoningEthylene glycol is readily available as a constituent of antifreezes for car radiatorsYoung children are sometimes attracted by the sweet taste of ethylene glycol and it has sometimes been used criminally to give 'body' and sweetness to white table wines.Ethylene glycol, itself, can only cause direct depression of central nervous system, however their oxidized products i.e., aldehyde and oxalates can cause severe metabolic acidosis and renal failure.Ethylene glycol poisoning can be divided into three stages.Management of Ethylene glycol poisoningSodium bicarbonate to correct acidemiaThiamine, folinic acid, magnesium and high dose pyridoxine to facilitate metabolism.Ethanol or Fomepizole is given to competitively inhibit the metabolism of Ethylene glycol. (Ethanol or Fomepizole occupies the enzyme alcohol dehydrogenase, and are metabolized instead of Ethylene glycol).Hemodialysis to eliminate ethylene glycol.
Paracetamol poisoning
Diethyl glycol poisoning
Severe malaria
Hanta virus infection
Toxicology