Question
A two year old boy presents with fever for 3 days which responded to administration of the drug shown below.
Three days later he developed acute renal failure, marked acidosis and encephalopathy. His urine showed plenty of oxalate crystals.
The blood anion gap and osmolal gap were increased. Which of the following is the most likely diagnosis ?
A. Paracetamol poisoning.
B. Diethy glycol poisoning.
C. Severe malaria.
D. Hanta virus infection.
Show Answer
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Correct Answer » B
Explanation
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Ans:B. Diethyl Glycol Poisoning
Patient is manifesting symptoms of Diethyl Glycol Poisoning due to ingestion of paracetamol syrup adulterated with diethylene glycol.
Ethylene Glycol Poisoning
- Ethylene glycol is metabolized by Alcohol dehydrogenate in the liver to – Glycoaldehyde Glyoxalic acid → Oxalic acid
- Toxicity is caused by oxalic acid
- Toxicity occurs in 3 stages
- Early symptoms (1-12 hr) – Gastric irritation, nausea, Vomitting, drowsiness, metabolic acidosis begins to develop.
- Symptoms at 12-24 hours – Cardiac dysrrhythmia, muscle pain, tetany due to hypocalcemia which occur due to binding and calcium with oxalic acid.
- Later stage (After 24 hrs) – Cardiac failure, seizure, cerebral edema and renal failure.
- Renal failure is caused due to deposition of calcium oxalate crystal in renal tubules.
- Calcium oxalate crystals are commonly seen in urine on microscopy.
- Intravenous sodium bicarbonate at doses of 1-2 mEq/Kg.
- Ethanol and/or Fomepizole to inhibit metabolism of ethylene glycol.
- Hemodialysis effectively removes ethylene glycol.
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