ETHYLENE GLYCOL

INDICATIONS

-EG DOSE: We recommend against ECTR based solely on the reported EG dose

-PLASMA EG CONCENTRATION

a. Fomepizole is used: we suggest ECTR if EG concentration is >50mmol/L (>310mg/dL)

b. Ethanol is used:

i. We recommend ECTR if EG concentration is >50mmol/L (>310mg/dL)

ii. We suggest ECTR if EG concentration is 20–50 mmol/L (124–310mg/dL)

c. No antidote is available: we recommend ECTR if EG concentration is >10mmol/L (>62mg/dL)

-OSMOL GAP (calculated as OSMmeasured − OSMcalculated, in SI units and adjusted for ethanol) when there is evidence of EG exposure

a. Fomepizole is used: we suggest ECTR if the osmol gap is >50

b. Ethanol is used:

i. We recommend ECTR if the osmol gap is >50

ii. We suggest ECTR if the osmol gap is 20–50

c. No antidote is available: we recommend ECTR if the osmol gap is >10

PLASMA GLYCOLATE CONCENTRATION

a. We recommend ECTR if the glycolate concentration is >12 mmol/L

b. We suggest ECTR if the glycolate concentration is 8–12mmol/L

ANION GAP (calculated as Na + K − Cl − HCO3) when there is evidence of EG exposure

a. We recommend ECTR if the anion gap is >27mmol/L

b. We suggest ECTR if the anion gap is 23–27mmol/L

CLINICAL INDICATIONS

a. Coma: we recommend ECTR

b. Seizures: we recommend ECTR

c. Kidney Impairment:

i. In patients presenting with CKD (eGFR <45mL/min/1.73m2): we suggest ECTR

ii. In patients with AKI (KDIGO stage 2 or 3): we recommend ECTR

MODALITY

a. When all ECTR modalities are available: we recommend using intermittent HD rather than any other type of ECTR

b. When intermittent HD is not available: we recommend using CKRT over other types of ECTR

CESSATION

a. We recommend stopping ECTR when the anion gap (calculated as Na + K − Cl − HCO3) is <18mmol/L

b. We suggest stopping ECTR when the EG concentration is <4mmol/L (25mg/dL)

c. We suggest stopping ECTR when acid–base abnormalities are corrected

Blood Purification in Toxicology:​Reviewing the Evidence and Providing Recommendations