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Indications for Hemodialysis in a Patient with Ethylene Glycol Poisoning Being Treated with Fomepizole

Description

Hemodialysis may aid in the rapid clearance of toxic levels of ethylene glycol. Certain clinical or laboratory findings can identify a patient who may benefit from the procedure. These indications are for patients being treated with fomepizole, an inhibitor of alcohol dehydrogenase that blocks metabolism of the ethylene glycol to glycolic and oxalic acids.


 

Indications for hemodialysis in a patient with ethylene glycol poisoning being treated with fomepizole include the presence of one or more of the following:

(1) initial arterial pH < 7.1

(2) decrease in arterial pH by 0.05 or more units despite intravenous administration of sodium bicarbonate

(3) decrease in serum bicarbonate by more than 5 mmol/L despite bicarbonate supplementation

(4) serum creatinine > 3 mg/dL (> 265 µmol/L)

(5) an increase in the serum creatinine concentration of >= 1 mg/dL (>= 88 µmol/L)

(6) an initial serum ethylene glycol concentration >= 50 mg/dL (>= 8.1 mmol/L)

 


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