What are the treatment and management options for Ethoxydiglycol exposure?

Management of Ethoxydiglycol Exposure

Treatment of ethoxydiglycol exposure should follow the same protocol as ethylene glycol poisoning, focusing on supportive care, antidotal therapy with alcohol dehydrogenase inhibitors, and extracorporeal treatment when indicated by severity markers.

Initial Assessment and Stabilization

• Immediate evaluation is required for any patient with suspected intentional ingestion, unknown amount ingested, or showing symptoms of toxicity 1
• Assess for metabolic acidosis by checking anion gap (Na+ + K+ - Cl- - HCO3-), with values >27 mmol/L indicating severe poisoning 2, 3
• Evaluate for neurological symptoms (altered mental status, seizures, coma), which may appear early in poisoning 2
• Check for signs of acute kidney injury, which is a common complication of glycol poisoning 2, 4

Decontamination Measures

• For dermal exposures, perform thorough cleansing with mild soap and water 1
• For ocular exposures, remove contact lenses if present and irrigate with room temperature tap water; refer for ophthalmologic examination if symptoms of eye injury develop 1
• Gastrointestinal decontamination with activated charcoal is generally not recommended as it does not effectively adsorb alcohols 5, 1
• Do not delay transportation to an emergency department for decontamination procedures 1

Antidotal Therapy

• Administer alcohol dehydrogenase (ADH) inhibitors to prevent metabolism of ethoxydiglycol to toxic metabolites 2, 6:
  • Fomepizole (preferred) or ethanol should be initiated promptly 2, 6
  • Dosage of antidotes must be adjusted during extracorporeal treatment as they are dialyzable 2

Extracorporeal Treatment (ECTR)

• ECTR is strongly recommended in the following scenarios 2:

  • When ethanol is used as antidote and ethylene glycol concentration >50 mmol/L or osmol gap >50
  • When glycolate concentration is >12 mmol/L or anion gap >27 mmol/L
  • In the presence of severe clinical features (coma, seizures, or acute kidney injury)

• ECTR is suggested (conditional recommendation) in these situations 2:

  • When fomepizole is used and ethylene glycol concentration >50 mmol/L or osmol gap >50
  • When glycolate concentration is 8-12 mmol/L or anion gap 23-27 mmol/L

• Intermittent hemodialysis is the preferred ECTR modality; if unavailable, continuous kidney replacement therapy (CKRT) is recommended 2

Monitoring and ECTR Cessation Criteria

• Continue ECTR until 2:

  • Anion gap is <18 mmol/L (strong recommendation)
  • Ethylene glycol concentration is <4 mmol/L (conditional recommendation)

• Monitor acid-base status, electrolytes, and renal function throughout treatment 2, 4

• All acid-base abnormalities should be reversed before stopping ECTR 2

Adjunctive Therapies

• Correct metabolic acidosis with sodium bicarbonate as needed 4
• Consider thiamine and pyridoxine as adjuvant therapy to support recovery 3
• Provide supportive care for organ dysfunction, particularly renal support if acute kidney injury develops 2, 4

Special Considerations

• Patients with alcohol use disorder may be at risk for alcohol withdrawal during treatment, especially if ECTR is performed 2
• Antidote dosing must be increased during ECTR due to removal by dialysis 2
• The absence of symptoms shortly after ingestion does not exclude a potentially toxic dose 1
• Patients should be treated at facilities capable of measuring glycol levels and with antidotes available 1