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1 <br />1 <br />PEAK Antifreeze Page <br />Inhalation: If inhaled, immediately remove victim to fresh air and call <br />emergency medlcat core. f not reathing gie artificial respiratiar. If <br />reathing is difficuh gie ogeo. <br />Irtgestioo: rain medical attention immediateL If patient is fully <br />conscious gie two glasses of water. o not induce omiting. If medical <br />advice is delayed, end if the person 6az swallowed a moderate volume of <br />material (a few ounces), then give three to four ounces of hard liquor, <br />such as whisk For children, give proportionally less liquor, accordarg <br />to weight. <br />Notes to Pbyslcian: <br />h is estimated that ttte lethal oral dose to adults is of the order of 1.0 <br />mUlcg. Ethyl®e glycol is metabolized by alcohol dehydrogenate to <br />various roetabdites including glycualdehydss, glycolic acid and oxalic <br />acid which cause ao Bleated anion gap metabolic acidtsis and renal <br />tuular into. The signs and symptoms in ethylene glycol poisming are <br />those of metaolic acidosis depression and kidne inur. <br />lhinalysis may show albuminuria, hematuria and oxaluria. Clinical <br />chemistr ma renal anion gap meraolic acidosis and uremia. The <br />currently recanmended medical management of ethylene glycol <br />poisoning incltt~s elimination of ethylene glycol and metabolites, <br />correction of metaolic acidosis and preention of kidne inur. It is <br />essential to have immediate and follow up urinalysis and clinical <br />chemistr, here should a particular emphasis ce acid base balance and <br />renal fimctioo tests. A contiartous infusion of 5% sodium bicarbonate <br />with frequent monitoring of electrolytes and fluid balance is usod to <br />achiee correction of metaolic acidosis and forced diuresis. As a <br />cartpetitie sustrau far aladro! dehdrogenase elhand is antidotal. <br />Given in the early stages of intoxication, it blocks the formulation of <br />nephrotoic metaolites. A therapeutically effective biaod concentration <br />of ethanol is in the range 100 150 mg/dl, and should be achieved by a <br />rapid loading dose and maintained intraenous infusion. For severe <br />andlor deteriorating cases hemadiatsis ma a reuired. Dialysis <br />should be considered fa patients who are symptomatic, have severe <br />metabolic acidosis, a blood ethylene glycol concattrazion greater than ZS <br />mdldl a canrpromise of renal fimaions. <br />A more effectie intraQiaLS antidote for pluician use is 4 <br />methylpyrazo}e, apotent inhibiter of alcohol dehydrog~rases, which <br />effectiel locks the formation of toic metaolites of ethlene glcal. It <br />has been toed to decrease the metabolic consequences of edryiene glycol <br />posoning before metabolic addcsis cans, seizures, and renal failure <br />hoe occurred. A generally recommended protocol is a (ceding dose of <br />t5 mglkg followed by 10 mgrlrg every 12 hours for 4 doses and rhea i5 <br />mg/kg every 12 haws until ethylene glya>t concentrations are bekow 20 <br />mg/t00 ml. low intraenous infusion is revered, ince 4 <br />medryplyrozde is dialyzable, increased dosage may be necessary during <br />hemodiatsis. Addirional therapemic measures may include the <br />administration of cofaxors involved in the metabolLsm of ethylene <br />Blcol. Thiamine (100 mg) and pyridoxine (50 mg) sh~xdd be given <br />hnp://vvww. peakanti freeze.cotn/tnsds/ful I force_msds. html <br />Page 3 of I 1 <br />9/24/0 l <br />