Ethanol acceptable substitute with appropriate monitoring
Treatment endpoint criteria
EG level < 3.2 mmol/L (20 mg/dL)
pH > 7.35
Osmolal gap normalized
Anion gap normalized
Asymptomatic for > 12 hours
Patient Discharge Instructions
copy discharge instructions
Ethylene glycol poisoning home care
Recovery instructions
Complete all prescribed medications including antidotes if outpatient
Drink adequate fluids as instructed by your doctor
Do not drive or operate machinery until fully cleared by your doctor
Kidney monitoring
Kidney function must be checked at your follow-up appointment
Report any decrease in urine output immediately
Report swelling in legs or face (sign of kidney problems)
Warning signs — return to emergency room immediately
Severe symptoms requiring immediate return
Confusion, drowsiness, or difficulty staying awake
Seizure or shaking episode
Unable to urinate for more than 8 hours
Severe nausea or vomiting preventing fluid intake
Muscle cramps, spasms, or tetany
Chest pain or palpitations
Rapid or difficult breathing
Worsening weakness
Mental health and safety
If poisoning was intentional
Follow-up with mental health provider is mandatory
Crisis line available 24 hours: 988 (Suicide and Crisis Lifeline)
Remove or secure all toxic substances from home
Antifreeze and ethylene glycol safety
Store antifreeze in original labeled containers, locked away
Keep out of reach of children and pets
Dispose of empty containers immediately
Follow-up plan
Mandatory follow-up appointments
Kidney specialist (nephrology) within 1 week
Family doctor within 2–3 days of discharge
Mental health provider as arranged before discharge
References
Guidelines and key sources
Toxicology guidelines
American College of Medical Toxicology (ACMT) — Fomepizole for ethylene glycol poisoning position statement
Fomepizole first-line antidote recommendation
Hemodialysis indications outlined
Extrip Workgroup — Extracorporeal Treatment for Ethylene Glycol Poisoning
Evidence-based hemodialysis indications
pH < 7.25, EG > 8 mmol/L, AKI criteria
ACEP Clinical Policy on toxic alcohol poisoning
Osmolal gap and anion gap diagnostic framework
Level B/C recommendations for antidote use
Key literature
Brent J et al. Fomepizole for the treatment of ethylene glycol poisoning (NEJM 1999)
Landmark trial establishing fomepizole safety and efficacy
Basis for current dosing protocol
Hovda KE et al. Anion gap and glycolate as prognostic markers in ethylene glycol poisoning
Anion gap > 28 mmol/L correlated with glycolate > 12 mmol/L and mortality
Glycolate < 8 mmol/L — 100% negative predictive value for death
Mégarbane B et al. Overall mortality approximately 18.7% in treated EG poisoning
Suicidal intent, coma, and hyperkalemia as poor prognostic factors
Coding and classification
ICD-10 T57.3X — Toxic effects of ethylene glycol
Accidental: T57.3X1A
Intentional self-harm: T57.3X2A
SNOMED CT: Ethylene glycol poisoning (disorder)
Concept aligns with toxic alcohol ingestion category
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.