Treatment for Polyethylene Glycol Poisoning
Polyethylene glycol (PEG) poisoning requires supportive care only, as it is fundamentally different from ethylene glycol poisoning and does not require antidotes or extracorporeal treatment. 1
Critical Distinction: PEG vs. Ethylene Glycol
It is essential to recognize that polyethylene glycol is NOT ethylene glycol—these are completely different substances with vastly different toxicities and management approaches:
- Polyethylene glycol is a relatively non-toxic polymer used in laxatives, pharmaceutical preparations, and as an agricultural adjuvant 1
- Ethylene glycol is the highly toxic component of antifreeze that requires aggressive intervention with antidotes and dialysis 2
The evidence provided predominantly addresses ethylene glycol poisoning, which is irrelevant to PEG toxicity.
Management of Polyethylene Glycol Poisoning
Supportive Care Approach
Provide aggressive supportive therapy focused on respiratory and hemodynamic support, as PEG toxicity can cause severe respiratory distress requiring mechanical ventilation. 1
- Airway management: Intubation and mechanical ventilation may be required for severe respiratory distress 1
- Monitor respiratory status closely: Respiratory compromise can develop 48 hours post-ingestion 1
- Hemodynamic support: Maintain adequate blood pressure and perfusion with intravenous fluids as needed 1
- Symptomatic treatment: Address gastrointestinal symptoms if present 1
What NOT to Do
Do not administer fomepizole, ethanol, or hemodialysis for PEG poisoning—these interventions are only indicated for ethylene glycol or other toxic alcohol poisonings 2. PEG does not undergo metabolism by alcohol dehydrogenase and does not produce toxic metabolites requiring these interventions.
Monitoring
- Serial clinical assessments: Monitor for development or progression of respiratory distress over 48-72 hours 1
- Vital signs: Continuous monitoring of respiratory rate, oxygen saturation, blood pressure, and heart rate 1
- Consider basic metabolic panel: To assess for any metabolic derangements, though these are not characteristic of PEG toxicity 1
Common Pitfall
The most critical error is confusing polyethylene glycol with ethylene glycol. If there is any suspicion of ethylene glycol co-ingestion (antifreeze exposure, unexplained metabolic acidosis with anion gap >27 mmol/L), then the aggressive treatment protocols for ethylene glycol poisoning must be initiated immediately 2, 3, 4.