Acute Ethylene Glycol Poisoning Following Accidental Mineral Oil Ingestion With Severe Metabolic Acidosis, Acute Kidney Injury, Respiratory Failure, and Delayed Neurological Sequelae: A Case Report.
Hao Yang, Yu Chen, LiLi Feng et al.
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Case in brief
A 57-year-old man became dizzy, vomited, and developed altered consciousness progressing to coma after accidentally ingesting mineral oil containing ethylene glycol. He presented with severe high-anion-gap metabolic acidosis (pH 7.0; anion gap 30.0 mmol/L), acute kidney injury, electrolyte abnormalities, and respiratory failure; ethylene glycol was detected in blood and gastric contents. He received ethanol therapy, organ support, and blood purification including continuous venovenous hemodialysis. Ethylene glycol was undetectable by day 5, and he was extubated on day 14. MRI showed infarcts and other abnormalities; at one-month follow-up, renal function had normalized and neurological symptoms had improved.
What made this case unusual
The toxic exposure followed accidental ingestion of mineral oil containing ethylene glycol, and neurological abnormalities persisted after the acute poisoning, with MRI showing a recent periventricular infarct, chronic lacunar infarcts, white-matter demyelination, and microhemorrhages.
Diagnostic / clinical pearl
Coma with vomiting, high-anion-gap metabolic acidosis, and renal dysfunction should prompt consideration of toxic alcohol exposure, including when the reported ingestion is of a product such as mineral oil.
Why it matters
Neurological assessment and follow-up remain relevant after ethylene glycol becomes undetectable, as this patient had MRI abnormalities and delayed neurological symptoms.