Continuous renal replacement therapy combined with fomepizole is effective in the clearance of ethylene glycol: a case report

AbstractEthylene glycol toxicity can be fatal without prompt treatment. Treatment options may include ethanol, fomepizole, and intermittent hemodialysis (IHD). IHD is usually preferred; however, depending on a patient’s clinical presentation continuous renal replacement therapy (CRRT) for the removal of ethylene glycol may be desirable. A 36-year-old male presented after transfer from a referring hospital with coma, severe acidosis, and elevated osmolal gap. With suspicion of toxic alcohol poisoning, an ethylene glycol serum concentration was ordered and eventually resulted at 163 mg/dL. The care team decided to initiate treatment with fomepizole and IHD. Due to severe hypotension requiring vasopressors, the patient underwent CRRT in lieu of IHD. We further describe the rapid clearance of ethylene glycol with concurrent fomepizole and CRRT. High flow rate continuous venovenous hemodiafiltration (CVVHDF) combined with fomepizole, removes ethylene glycol from the body in a timely manner