Accidental poisoning or medication misuse?

December 26, 2018

Figure 1 Quiz of the Week

A 20-year-old mechanic is brought to the emergency room after his co-workers found him exiting the garage inebriated and confused hours earlier. On examination, he is disoriented, ataxic, and complains of nausea. A urine toxicology screen is negative and urinalysis reveals the rhomboid calcium oxalate crystals seen here.

Which of the following treatments should be initiated?

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Image credit: @nikhilchadha.

Answer: Fomepizole

This patient has ethylene glycol (antifreeze) poisoning, demonstrated by the envelope-shaped calcium oxalate crystals seen here. Fomepizole — which inhibits the formation of toxic metabolites — is the preferred treatment for ethylene glycol poisoning. Severely poisoned patients presenting with acidosis may also require hemodialysis.

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