Abstract
Severe high-anion gap metabolic acidosis is a medical emergency in the Intensive Care Unit and is associated with high morbidity and mortality. Ethylene glycol poisoning is an uncommon but potentially fatal cause, often diagnosed late and challenging to manage, particularly in settings with limited access to specific antidotes. We report the case of an 18-year-old female patient with a history of autism spectrum disorder and moderate intellectual disability who was admitted to the Intensive Care Unit 24 hours after accidental ingestion of ethylene glycol. The patient developed toxic-metabolic encephalopathy and severe high–anion gap metabolic acidosis (pH 6.99; HCO₃⁻ 2-3 mEq/L), accompanied by critical hyperkalemia and acute kidney injury (KDIGO stage 3). In the absence of specific antidotes, advanced life support and urgent hemodialysis through serial sessions were initiated, resulting in rapid correction of metabolic disturbances, full recovery of renal function, and a favorable clinical outcome. This case highlights the importance of systematic acid–base assessment and early hemodialysis as key strategies to improve outcomes in ethylene glycol poisoning.
References
1. Hopkins E, Sanvictores T, Sharma S. Physiology, Acid Base Balance. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507807/
2. Sánchez-Díaz JS, Martínez-Rodríguez EA, Méndez-Rubio LP, Peniche-Moguel K. Equilibrio ácido-base. Puesta al día. Teoría de Henderson-Hasselbalch. Med Int Mex. 2016;32(6):640–660. Disponible en: https://medicinainterna.org.mx/article/equilibrio-acido-base-puesta-al-dia-teoria-de-henderson-hasselbalch/
3. Hidalgo-Acosta IV, Mena-Miranda VR, Fernández de la Paz B, Heredero-Valdés M, Ruiz-Baldrich WA. Acidosis metabólica: un reto para los intensivistas. Rev Cubana Pediatr [Internet]. 2005;77(2) [Consultado el 20 de diciembre de 2025]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75312005000200008
4. Sepúlveda AR, Selamé E, Roessler E, Tagle R, Valdivieso A. Intoxicación por etilenglicol: fisiopatología y enfrentamiento clínico. Rev Med Chil. 2019;147(12):1572–1578. doi:10.4067/S0034-98872019001201572
5. Gallagher N, Edwards FJ. The Diagnosis and Management of Toxic Alcohol Poisoning in the Emergency Department: A Review Article. Adv J Emerg Med. 2019 May 22;3(3):e28. doi: 10.22114/ajem.v0i0.153.
6. Sasanami M, Yamada T, Obara T, Nakao A, Naito H. Oral ethanol treatment for ethylene glycol intoxication. Cureus [Internet]. 2020;12(11):e12268 [Consultado el 20 de diciembre de 2025]. doi:10.7759/cureus.12268
7. Stašinskis R, Stašinska K, Mukāns M, Graudiņš A, Liguts V, Lejnieks A. Changes in ionized calcium in ethylene glycol poisoning. Proc (Bayl Univ Med Cent). 2022 Apr 27;35(4):460-465. doi: 10.1080/08998280.2022.2062550.
8. Carrasco-Nieva M, Sánchez-Villegas MC. Intoxicación por etilenglicol: reporte de caso, un reto en el tratamiento en la sala de urgencias. Arch Med Urg Mex [Internet]. 2024;16(2):140–148 [Consultado el 20 de diciembre de 2025]. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=117761
9. Kraut JA, Madias NE. Metabolic acidosis: pathophysiology, diagnosis and management. Nat Rev Nephrol. 2010 May;6(5):274-85. doi: 10.1038/nrneph.2010.33.
10. Esper RC, González D, Quintana L, Rea E, Bravo L. Intoxicación por etilenglicol: reporte de un caso y revisión de la literatura. Acta Médica [Internet]. 2006;4(4):243–248 [Consultado el 20 de diciembre de 2025]. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=11128
11. Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA; American Academy of Clinical Toxicology Ad Hoc Committee on the Treatment Guidelines for Methanol Poisoning. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning. J Toxicol Clin Toxicol. 2002;40(4):415-46. doi: 10.1081/clt-120006745.
12. Laverde-Sabogal CE, Valencia-Cárdenas AR, Vega-Sandoval CA. Una causa inusual de acidosis metabólica severa: ayuno prequirúrgico. Rev Colomb Anestesiol [Internet]. 2014;42(4):312–316 [Consultado el 20 de diciembre de 2025]. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-33472014000400010
13. Brent J. Fomepizole for ethylene glycol and methanol poisoning. N Engl J Med. 2009;360(21):2216–2223. doi:10.1056/NEJMct0806112
14. Kruse JA. Methanol and ethylene glycol intoxication. Crit Care Clin. 2012;28(4):661–711. doi:10.1016/j.ccc.2012.07.002
15. Duraković Z, Gasparović V, Plavsić F. Otrovanje etilen glikolom lijeceno hemodijalizom [Ethylene glycol poisoning treated with hemodialysis]. Arh Hig Rada Toksikol. 1990 Jun;41(2):201-7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/2248555/
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 Maria Rene Sendoya Alvarez, Agar Melvy Paredes Carpio, Rommer Alex Ortega Martinez, Edson Américo Antequera Rocha (Author)