Answer: VizD Image Challenge Week of 4/16/2007

Congratulations to MATT - he is the first person to submit the correct answer to this week's VizD.

To view Matt's answer, click here

MATT is the winner of $5.

Recap:
A 25-year-old man with a history of depression was brought unresponsive to your Emergency Department. He had been seen earlier in the evening at a local bar, where he got into an argument with his girlfriend. Upon returning home, his roommate noted that the patient appeared "drunk". Three hours later he was found unresponsive and breathing rapidly. His roommate called 911.

In the ED, you receive a sample of urine as seen below and perform a procedure on it.

1. What is the inciting agent that caused this patient's presentation?
2. Name two hallmark laboratory findings seen with this condition?
3. Name three agents that can be used to treat this condition?




Answers:
1. Ethylene glycol
2. Anion gap metabolic acidosis, osmolal gap
3. Ethanol, fomepizole, dialysis

For a review on the topic, check out the article Ethylene Glycol Poisoning: Case Report of a Record-High Level and a Review (Journal of Emergency Medicine. 15(5); 1997. 653-67)

Abstract

Ethylene glycol is commonly found in automobile antifreeze and a variety of other commercial products. Ingestion of ethylene glycol, either accidentally or in a suicide attempt, is characterized by severe acidosis, calcium oxalate crystal formation and deposition, and a wide variety of end organ effects that may be fatal. We present a case of a patient who ingested a massive amount of ethylene glycol in a suicide attempt and yet survived with minimal sequelae. A comprehensive review of the literature on the pathology and pathophysiology of ethylene glycol toxicity on each organ system is provided, along with information on diagnosis and current treatment recommendations.

Click on the link below for previously published post on ethylene glycol
NY Emergency Medicine: Nice Pickup...A Glowing Intoxication

The next VizD will be posted on Monday April 23rd

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient. For more information please refer to the following link.