Ethylene Glycol Toxicity

TL;DR. Nemrznoucí směs způsobí trvalé selhání ledvin bez antidota během hodin.

Sladké louže lákají zvířata.

Co to je?

Sweet antifreeze/de-icer. Liver metabolites cause severe metabolic acidosis and renal tubular necrosis with calcium oxalate crystals. Minutes matter.

Příčiny a rizikové faktory

Automotive antifreeze, some washer fluids, heat exchangers. Outdoor access to garages/driveways. Cats: ~1 teaspoon can kill; dogs: a few tablespoons.

Známky

• Phase 1 (0.5-12 h): ataxia, vomiting, polyuria/polydipsia ("drunk")
• Phase 2 (12-24 h): seeming improvement but tachycardia/tachypnea
• Phase 3 (12-72 h): severe depression, anuria, seizures, uremic breath
• Metabolic acidosis, AKI, tubular necrosis, oxalate crystals (common)

Časná fáze jako opilost: nestabilita.

Diagnostika

Rapid ethylene glycol blood screen (early only), urinalysis for picket-fence oxalate crystals, chemistry/blood gas for azotemia and high anion-gap acidosis.

"Once the patient has been appropriately decontaminated, the focus of treatment should be based on symptomatic and supportive care."

Rychlý krevní screening před úplnou metabolizací.

Léčba

Antidotes: preferred Fomepizole; if unavailable Ethanol. Never combine fomepizole and ethanol. Aggressive IV fluids; hemodialysis if available for established failure.

Prognóza

Dogs: good if antidote within ~8 h. Cats: good only within ~3 h; delay beyond ~4 h nearly always fatal without hemodialysis. Established anuric AKI: grave.

Prevence

Seal antifreeze high and dry; clean spills immediately; prefer propylene-glycol coolants; leash walks; keep cats indoors.

Kdy volat

Any suspected antifreeze exposure is Level-5 emergency. Do not wait for "drunk" signs; go to ER now.

Zdroje

• Small Animal Critical Care Medicine, 2nd Edition, page 437.
• Plumb's Veterinary Drug Handbook, pages 1411, 1594, 1596.

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