Een patiënte gered door alcohol

Abstract

A patient saved by alcohol The medical history of a 43-year-old female patient with auto-intoxication of ethylene glycol is reported. Ethylene glycol is a toxic alcohol leading to severe complications if not treated early. Ethylene glycol itself is relatively nontoxic, however life-threatening toxicity appears after metabolization in the liver. These toxic metabolites lead to metabolic acidosis, renal failure, multiple organ failure and death. A quick diagnosis and therapeutic management are important to avoid formation of the metabolites. Serum drug levels give certainty regarding diagnosis, but are rarely available in time to guide management. There is often a strong suspicion or clear history of auto-intoxication. Shortly after large ingestions, patients may present with sedation or inebriation and have a large osmolar gap, but minimal acidosis. After several hours a profound metabolic acidosis with high anion gap will be present. Management involves supportive care, administration of sodium bicarbonate to correct systemic acidosis, inhibition of the enzyme alcohol dehydrogenase with either fomepizole or ethanol, haemodialysis and treatment with cofactors to optimize nontoxic metabolic pathways. Methanol poisoning is also discussed in this article, as methanol is another toxic alcohol with a similar therapeutic management.