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Clinical Presentation
The clinical presentation of ethylene glycol toxicity is generally divided into three fairly well-defined phases:
1. CNS Depression Phase
The first phase occurs within 30 minutes to 12 hours. At this phase, the patient may appear intoxicated with nausea, vomiting, ataxia, absent reflexes, nystagmus, and myoclonic jerks but has no smell of alcohol. Coma and seizures (focal or generalized) may occur or there may be tetany if hypocalcemia is present. CNS depression may be from the ethylene glycol itself or from the metabolites. Abdominal pain, myalgias, and hematemesis may be present. Dilated pupils with loss of the light reflexes, papilledema, and blurred optic discs have been reported with ethylene glycol intoxication, but are much more common in methanol poisoning.
2. Cardiopulmonary Toxicity Phase
This phase usually begins at 12-72 hours after ingestion. At this point mild hypertension, tachycardia, and tachypnea may be seen. If toxicity is severe this may progress to congestive heart failure, pulmonary edema, and pneumonitis. This phase is thought to be the result of calcium oxylate crystals within the vascular tree, lung parenchyma, and the myocardium.
3. Renal Toxicity Phase
This phase occurs 24-72 hours after ingestion and consists of flank and abdominal pain with evidence of acute tubular necrosis that is manifest as oliguric renal failure.
CC.
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