Ethylene glycol

Following last week’s Paucis Verbis card on calculating the osmolal gap, here is the first installment of the Toxic Alcohols cards. First up — ethylene glycol. There are useful American Academy of Clinical Toxicologists recommendations on when to administer an antidote (fomipezole) and when to perform hemodialysis.

Here’s a quick review of the metabolism of the different toxic alcohols. The parent compounds for ethylene glycol and methanol are innocuous and the metabolites are toxic.

PV Card: Ethylene Glycol Toxicity

Adapted from [1-3]
Go to ALiEM (PV) Cards for more resources.

See Dr. Leon Gussow’s great review on The Poison Review and tips of a recent Annals of EM4 paper on identifying a small subset of patients with ethylene glycol who did well despite NOT receiving hemodialysis.


  1. Kraut J, Kurtz I. Toxic alcohol ingestions: clinical features, diagnosis, and management. Clin J Am Soc Nephrol. 2008;3(1):208-225. [PubMed]
  2. Jammalamadaka D, Raissi S. Ethylene glycol, methanol and isopropyl alcohol intoxication. Am J Med Sci. 2010;339(3):276-281. [PubMed]
  3. Marraffa J, Cohen V, Howland M. Antidotes for toxicological emergencies: a practical review. Am J Health Syst Pharm. 2012;69(3):199-212. [PubMed]
  4. Levine M, Curry S, Ruha A, et al. Ethylene glycol elimination kinetics and outcomes in patients managed without hemodialysis. Ann Emerg Med. 2012;59(6):527-531. [PubMed]
Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at Bio:
Michelle Lin, MD