BACKGROUND
Ethylene glycol poisoning is uncommon but life-threatening. Early manifestations can mimic ethanol intoxication, while delayed recognition can lead to severe acid-base, renal, cardiopulmonary, and neurological complications. This report describes the case of a 57-year-old man who unintentionally ingested mineral oil containing ethylene glycol and presented with coma, a high anion gap metabolic acidosis, acute kidney injury, respiratory failure, and delayed neurological abnormalities.
CASE REPORT
A 57-year-old Han Chinese man developed dizziness, vomiting, wheezing, drowsiness, ataxia, dysarthria, and coma within 12 hours of accidental ingestion of mineral oil containing ethylene glycol. On admission, the Glasgow Coma Scale score was 3, and he had severe metabolic acidosis (pH 7.0, bicarbonate 2.70 mmol/L, anion gap 30.0 mmol/L), hyperkalemia, hypocalcemia, acute kidney injury, and respiratory failure. The blood ethylene glycol concentration was 456.8 μg/mL, and gastric contents were positive. Treatment included intubation, mechanical ventilation, ethanol therapy, correction of acidosis and electrolyte disturbances, organ support, and early bedside blood purification followed by continuous venovenous hemodialysis. Ethylene glycol was undetectable on day 5, and he was extubated on day 14. Brain magnetic resonance imaging (MRI) on day 19 showed a recent right periventricular infarct, chronic lacunar infarcts, white-matter demyelination, and microhemorrhages. He was transferred to the general ward on day 24 and discharged on day 30. At the 1-month follow-up, serum creatinine levels had returned to normal and neurological symptoms had improved.
CONCLUSIONS
Severe ethylene glycol poisoning should be suspected in patients with coma, vomiting, high anion gap metabolic acidosis, renal dysfunction, and a history of possible toxic alcohol exposure. Early antidotal therapy, extracorporeal treatment, serial toxicological, renal, respiratory, and neurological assessments and follow-up are essential.

Keywords: Acute Kidney Injury; Hemodialysis Solutions; Neurological Rehabilitation; Case Reports; Ethylene Glycol; Poisoning