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' . • P. EAK Anti freeze Page <br />linhalatiop: if inhaled, immediately remove victim to fresh air and call <br />emergency medical care. f not reathing gie artificial respiration. If <br />reathing is difficult gie ogee. <br />Ingestion: fain medical attention immediatel. If patient is fully <br />conscious gie two glasses of water. o not induce omiting. If medical <br />advice is delayed, and if the person has swallowed a moderate volume of <br />material (a few ounces), then give three to four canoes of hard liquor, <br />such as whisk. For children, give proportionally less liquor, according <br />to weight. <br />Notes to Physician: <br />it is estimated that the lethal oral dose to adults is of the order of 1.0 <br />mllkg. Ethylene glycol is metabolized by alcohol dehydrogenate to <br />various metabolites including glyceraldehydes, glycolic acid and oxalic . <br />acid which cause an elected anion gap metabolic acidosis and renal <br />tuular inur. The signs and symptoms in ethylene glycol poisoning are <br />those of metaolic acidosis depression and kidne inur. <br />Urinalysis may show aiburninuria, hematuria and oxaluria. Clinical <br />chernisir ma reeal anion gap metaolic acidosis and uremia. The <br />currently recommended medical management of ethylene glycol <br />poisoning includes 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 on acid base balance and <br />renal function tests. A continuous infusion of S% sodium bicarbonate <br />with frequent monitoring of electrolytes and Iluid balance is used to <br />achiee correction of metaolic acidosis and forced diuresis. As a <br />competitie sustrate for alcohol dehdrogenase ethanol is antidotal. <br />Given in the early stages of intoxication, it blocks the formulation of <br />nephrotoic metaolites. A therapeutically effective blood concentration <br />of ethanol is in the range 100 150 mgldl, and should be achieved by a <br />rapid loading dose and maintained intraenous infusion. For severe <br />and/or deteriorating cases hemodiaLsis ma a rewired. pialysis <br />should be considered for patients who are symptomatic, have severe <br />metabolic acidosis, a blood ethylene glycol concentration greater than 25 <br />md/dl or compromise of renal functions. <br />A more effectie intraenous antidote for phsician use is 4 <br />methylpyrazole, apotent inhibitor of alcohol dehydroge,~nases, which <br />effectiel locks the formation of toic metaolites of ethlene glcol. It <br />has been used to decease the metabolic consequences of ethylene glycol <br />poisoning. before metabolic acidosis coma, seizures, and renal failure <br />hoe occurred. A generally recommended protocol is a loading dose of <br />15 mg/kg followed by 10 mg/kg every 12 hours for 4 doses and then 15 <br />mg/kg every l2 hours until ethylene glycol concentrations are below 20 <br />mg/100 ml. low intraenous infusion is rewired. ince 4 <br />methyplyrozoie is dialyzable, increased dosage may be necessary during <br />hemodialsis. Additional therapeutic measures may include the <br />administration of cofactors involved in the metabolism of ethylene <br />glcol. Thiamine (100 mg} and pyridoxine (50 mg) should be given <br />Page 3 of 11 <br />http:l/www.~eakantifreeze.com/msds/fullforce_msds.html 9/24/l)l <br />