MedBugs: SAQ #238

Case: Ethylene glycol poisoning

A 25-year-old female (70 kg) presents after being unconscious by a friend. A suicide letter was found by her friend suggesting an ingestion, but the agent is not clear. She has a GCS 3, RR 28, SaO2 98% RA, HR 130 and BP 90/40 VBG: pH 6.8 (RR: 7.35 – 7.45) pCO2 26 HCO3 3 mmol/L (RR: 22-29) lactate > 20 mmol/L) (RR: < 2) Na 141 mmol/L (RR: 135 – 145) Cl 110 mmol/L (RR: 96 – 110) K 8.1 mmol/L (RR: 3.5 – 5.5) Cr 182 µmol/L (RR: 45 – 90) urea 10 mmol/L (RR: 2.5 – 7.5) BSL 5 Serum osmol 350 mosm/L Ethanol < 2mmol/L

1. Outline four abnormalities on the venous blood gas and biochemistry including calculations. 4 marks

2. List three differential diagnoses for this patient’s metabolic disturbance. 3 marks

It has become evident she ingested 300ml of a 50% car engine coolant

3. Outline five important aspects of immediate management including doses and endpoints where relevant. 10 marks

4. Outline three adjustments to your intubation plan in a severely acidaemic patient. 3 marks

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Case: Ethylene glycol poisoning

1. Outline four abnormalities on the venous blood gas and biochemistry including calculations. 4 marks

2. List three differential diagnoses for this patient’s metabolic disturbance. 3 marks

3. Outline five important aspects of immediate management including doses and endpoints where relevant. 10 marks

4. Outline three adjustments to your intubation plan in a severely acidaemic patient. 3 marks

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