Indications to begin empiric treatment:
(1) History of ethylene glycol ingestion.
(2) Ethylene glycol serum levels > 20 mg/dL
(3) Urine findings - one or both of the following:
(3a) calcium oxalate crystals
(3b) urine fluoresces under the Wood's lamp (if antifreeze containing sodium fluorescein ingested)
(4) Suspected suicide attempt without clinical, laboratory or ECG evidence of other toxins.
(5) Unexplained metabolic acidosis (pH < 7.3), especially with:
(5a) wide anion gap (especially if > 16-20)
(5b) wide osmolar gap (> 10)
(6) Intoxicated appearance without smell of ethanol or with serum levels inadequate to account for the symptoms:
(6a) decreased level of consciousness
(6b) ataxia
(6c) slurred speech
(6d) nonfocal neurologic examination
NOTE: While empiric therapy should be started if there are clinical findings suspicious for ethylene glycol exposure, chemical analysis to confirm the ingestion should be performed.
