CME: Ethylenglykol-Intoxikation
Abstract
Zusammenfassung. Ethylenglykol ist ein süsslich schmeckender Alkohol (einfachster zweiwertiger Alkohol, Synonym «Glykol»), der in handelsüblichen Frostschutzmitteln und anderen industriellen Lösungen verwendet wird. Ohne adäquate Therapiemassnahmen kann eine Intoxikation mit Ethylenglykol zu einer schweren metabolischen Azidose, zum akuten Nierenversagen und zum Tod führen. Nach gastrointestinaler Resorption findet die Metabolisierung überwiegend hepatisch, unter anderem durch die Alkoholdehydrogenase, statt und resultiert in einer schweren metabolischen Azidose mit Anionenlücke und der Bildung von Kalziumoxalat-Kristallen, die sich in verschiedenen Geweben ablagern können. In der Niere führt dies zur akuten Tubulusnekrose mit potenziell reversiblem Nierenversagen. Therapeutisch entscheidend ist die schnellstmögliche Inhibition der Alkoholdehydrogenase durch Fomepizol oder Ethanol, um die Bildung toxischer Metaboliten zu verhindern. Die Hämodialyse bietet die effektivste Methode der sekundären Dekontamination. Bei frühem Therapiebeginn ist die Prognose günstig.
Abstract. Ethylene glycol is a sweet-tasting alcohol used in common antifreeze and other industrial solutions. Without appropriate therapy, intoxication with ethylene glycol can result in severe metabolic acidosis, acute renal failure, and in death. After gastrointestinal resorption, hepatic metabolism starts with oxidation by alcohol dehydrogenase and results in severe anion gap metabolic acidosis. Other metabolic products are calcium oxalate crystals, which can deposit in several tissues like the kidneys and lead to acute tubular necrosis with reversible renal failure. The crucial therapeutic step is rapid inhibition of alcohol dehydrogenase with fomepizole or ethanol to avoid the formation of toxic metabolites. Additionally, haemodialysis is the most effective way to eliminate ethylene glycol as well as its toxic metabolites. If therapy is initiated rapidly, prognosis is favorable.
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