A two-year-old boy presents with fever for 3 days which responded to administration of paracetamol. Three days later he developed acute renal failure, marked acidosis and encephalopathy. His urine showed plenty of oxalate crystals. The blood anion gap and osmolar gap were increased. Which of the following is the most likely diagnosis –
Correct Answer: Diethy glycol poisoning
Description: ETHYLENE GLYCOL POISONING
Ethylene glycol is metabolized by Alcohol dehydrogenate in the liver to
Glycoaldehyde → Glyoxalic acid → Oxalic acid
Toxicity is caused by oxalic acid
Toxicity occurs in 3 stages
Early symptoms (1-12 hr) - Gastric irritation, nausea, Vomiting, drowsiness, metabolic acidosis begins to develop.
Symptoms at 12-24 hours - Cardiac dysrhythmia, muscle pain, tetany due to hypocalcaemia which occur due to binding and calcium with oxalic acid.
Later stage (After 24 hrs) - Cardiac failure, seizure, cerebral edema and renal failure.
Renal failure is caused due to deposition of calcium oxalate crystal in renal tubules.
Calcium oxalate crystals are commonly seen in urine on microscopy.
Management -
Intravenous sodium bicarbonate at doses of 1-2 mEq/Kg.
Ethanol and/or Fomepizole to inhibit the metabolism of ethylene glycol.
Hemodialysis effectively removes ethylene glycol.
Category:
Pediatrics
Get More
Subject Mock Tests
Practice with over 200,000 questions from various medical subjects and improve your knowledge.
Attempt a mock test nowMock Exam
Take an exam with 100 random questions selected from all subjects to test your knowledge.
Coming SoonGet More
Subject Mock Tests
Try practicing mock tests with over 200,000 questions from various medical subjects.
Attempt a mock test now