Q: 22 years old male is admitted to ICU with suspected Ethylene Glycol toxicity. Patient is intubated, getting IVF boluses, pyridoxine, and thiamine, which are administrated, and fomepizole is on its way from the pharmacy. You also called renal service for backup to initiate hemodialysis (HD) if needed. Meanwhile, the nurse handed you the ECG, which showed a prolonged QT interval. What is your first thought? (select one)
A) Hypokalemia
B) Hyperkalemia
C) Hypercalcemia
D) Hypocalcemia
E) Hypomagnesemia
Answer: D (Hypocalcemia)
A prolonged QT interval in Ethylene Glycol toxicity signifies a major problem and possible impending renal failure. Urinary crystal formation requires a sufficient amount of time for ethylene glycol to be metabolized into oxalate. Calcium oxalate formation depletes serum calcium. Developing oliguria or anuria in the presence of hypocalcemia is a sign of impending renal failure and may require the institution of HD.
Indications of HD in ethylene glycol toxicity should depend on the overall clinical situation but generally include pH < 7.25, acute renal failure, Ethylene glycol level >50, or Serum glycolic acid >8.
#toxicology
#nephrology
Reference:
1. Stašinskis R, Stašinska K, Mukāns M, Graudiņš A, Liguts V, Lejnieks A. Changes in ionized calcium in ethylene glycol poisoning. Proc (Bayl Univ Med Cent). 2022 Apr 27;35(4):460-465. doi: 10.1080/08998280.2022.2062550. PMID: 35754577; PMCID: PMC9196768.
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