EMRA Simulation Guide

Toxicology - Ethylene Glycol Toxicity

CASE: 41-year-old male brought in with altered mental status and shortness of breath

Learning Objectives

1. Recognize when an adult has an immediate life-threatening condition
2. Manage an altered patient with unknown ingestion
3. Create a broad differential for a patient with unknown ingestion
4. Order appropriate studies to elucidate the cause of patient’s clinical condition
5. Be able to calculate and interpret anion and osmolar gap

Critical Actions

• Obtain IV access with two large-bore peripheral IVs
• Supplemental oxygen
• Place patient on monitors with continuous oxygen saturation monitoring
• Ask for a full set of vital signs including HR, BP, oxygen saturation, and temperature
• Obtain EKG
• Ask for and interpret appropriate labs including acetaminophen, salicylate, and toxic alcohols.
• Administer IV fluids
• Administer fomepizole IV
• Reassess patient and vital signs
• Call appropriate consultations: poison center/toxicology, admitting physician
• Closed loop communication
• Synthesis of the case
• Disclose appropriate information to the patient/family

Download the case here.