Two Cases of Ethylene Glycol Poisoning Treated Successfully with Haemodialysis

Introduction: Ethylene glycol is an organic toxic compound found in many household items including radiator coolants and brake oil. Toxic effects of ethylene glycol are due to its metabolites glycolic acid and oxalic acid which cause potentially fatal metabolic acidosis and renal failure. Here we discuss two cases of ethylene glycol poisoning with literature review on pathophysiology, clues in diagnosis and therapy. Case presentations: First case is of a teenage girl presenting with unexplained persistent drowsiness. She went on to develop acidotic breathing and anuria. Unexplained metabolic acidosis and acute kidney injury inclined us towards ethylene glycol poisoning. On further questioning, she confirmed taking radiator coolant 5 hours before admission. The second case is of a young automobile serviceman who presented with unexplained markedly reduced level of consciousness. He had high anion gap metabolic acidosis, calcium oxalate crystals in urine and basal ganglia hypodensities in non-contrast CT. He later developed acute kidney injury. Ethylene glycol poisoning was suspected which was later confirmed when the patient regained consciousness. Both patients responded well to haemodialysis and recovered without complications. Discussion: Ethylene glycol is an easily accessible toxic compound that can be used as a suicidal agent. High anion gap metabolic acidosis, acute kidney injury, calcium oxalate crystalluria and altered sensorium are highly suggestive. Conclusions: A high degree of suspicion is needed for early diagnosis. Haemodialysis can be used effectively to remove the toxic metabolites and treat the renal impairment. Early recognition will save lives without long term renal or neurologic complications

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries