NEJM discussion of ethylene glycol poisoning misses crucial points

2 out of 5 stars Case 4-2015: A 49-Year-Old Man with Obtundation Followed by Agitation and Acidosis. Cooper CM, Baron JM. N Engl J Med 2015 Jan 29;372:465-473. Reference This episode of the Journal‘s “Case Records of the Massachusetts General Hospital” series is the latest of their amazing inept discussions of medical toxicology cases. Yet again, the discussants do not include a medical toxicologist or emergency physician. Given the level of toxicological awareness evidenced by this case presentation, it’s fortunate that the patient did well. A unresponsive 49-year-old man was found outside with a half-empty bottle of cloudy liquid and an empty bottle of trazodone that had been filled earlier that day. On arrival in the emergency department, he would open his eyes and move his extremities in response to painful stimuli, but did not speak (Glasgow Coma Score = 8.) His vital signs were unremarkable, his serum glucose was 98 mg/dL, bicarbonate 23.9 mom/liter and anion gap 21. Other basic labs, including serum calcium and creatinine, as well as salicylate and acetaminophen levels, were unremarkable. I have simplified the details of the case somewhat, but let’s stop here. We have an intermittently unresponsive and agitated man with a metabolic acidosis (evidenced b the increased anion gap) who had been found with a half-empty bottle of liquid. What would be the next steps in managing this patient? Click here for the answer expand(document.getElementB...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical case records of the massachusetts general hospital ethylene glycol poisoning fomepizole management medical toxicology new england journal of medicine Source Type: news