ETHYLENE GLYCOL POISONING AND ITS

ANTIDOTE
Submitted By: Benish Baseerat
Submitted To: Sir Aziz ur Rahman
Class No: 5th
Roll No: 513
Semester: 7th
Assignment: Hospital pharmacy
Dated : 30 November 2020
Session: 2017-2022

Department of Pharmacy
University Of Malakand
Ethylene Glycol:

Ethylene glycol is an organic compound. It is odorless, colorless, sweet tasting syrup. It is

moderately toxic. The major danger is due to its sweet taste which can attract children and
animals. It firstly affects the CNS.

MECHANISM OF POISONING

• Ethylene glycol is metabolized by alcohol dehydrogenase to glyceraldehyde, which is then metabolized

to glycolic, glyoxylic, and oxalic acids. These acids, along with excess lactic acid, are responsible for the
anion gap metabolic acidosis. Oxalate readily precipitates with calcium to form insoluble calcium oxalate
crystals. Tissue injury is caused by widespread deposition of oxalate crystals and the toxic effects of
glycolic and glyoxylic acids.
SIGNS AND SYMPTOMS OF POISONING

 Seizures
 Coma
 Cerebral edema (in some cases)
 Tachycardia
 Tachypnea
 Hypertension or hypotension
 Flank pain
 Costovertebral angle tenderness
 Oliguric renal failure

DIAGNOSIS

Laboratory tests which include

 Complete blood count

 Serum electrolytes
 Alcohol toxicology panel with ethanol,
 Blood urea nitrogen
 Urinalysis
 Serum ethylene glycol level
 Calcium and magnesium levels
Mechanism of action of ANTIDOTE: ETHANOL AND FOMEPIZOLE
(ANTIZOL)

Fomepizole

It acts as an inhibitor of alcohol dehydrogenase and therefore prevents the formation of acidic
ethylene glycol metabolites.

Doses:

It is administered in divided doses

 Loading dose 15 mg / kg
 Maintainance dose 10 mg / kg every 12 hours for 4 doses

Administer fomepizole or ethanol to saturate the enzyme alcohol dehydrogenase and prevent
metabolism of ethylene glycol to its toxic metabolites

Ethanol (ethyl alcohol) acts as a competitive substrate for the enzyme alcohol dehydrogenase ,
preventing the metabolic formation of toxic metabolites from methanol or ethylene glycol.

Route of Administration:

Fomepizole (Antizol) should be ingested orally as well as administered as a slow IV infusion

over 30 minutes.

Plan of Administration:

Dilute each dose of fomepizole in 100 mL of sodium chloride 0.9% or dextrose 5% in water and
administer over 30 minutes. It should not be administered undiluted or direct.
Management:

Ethylene glycol is rapidly absorbed from the stomach, making treatment with gastric lavage and
syrup of ipecac in affective .It requires large amounts of activated charcoal to bind relatively
small amounts of ethylene glycol and the therapeutic window for this action is less than an hour.
Traditional treatment of ethylene glycol poisoning consists of sodium bicarbonate, ethanol and
hemodialysis. Fomepizole (Antizol) is a new agent with a specific indication by the U.S food and
drug administration for the treatment of ethylene glycol poisoning. It act as inhibitors of alcohol
dehydrogenase and therefore prevent the formation of acidic ethylene glycol metabolites.
Fomepizole (antizol) slower rate of excretion by the kidneys, lack of CNS depression or
hypoglycemia, and easier maintenance of effective plasma levels.