Acute exposure

Inhalation

The victim should be removed from exposure and all contaminated clothing removed. The respiratory function should be assessed. Further treatment is symptomatic and supportive. See below for management of systemic effects.

Dermal

Contaminated clothing should be removed and the skin thoroughly irrigated with water or saline. Further treatment is symptomatic and supportive. See below for management of systemic effects.

The eyes should be thoroughly irrigated with water or saline for 15 minutes and then stained with fluorescein. Referral to an ophthalmologist is recommended if there is any uptake of fluorescein.

Ingestion

Gastric decontamination should be considered following ingestion of a large quantity. Most cases reported involved intentional suicidal ingestion or accidental ingestion in mistake for alcohol. Cases reported in the literature are summarised in Table 11.9. Activated charcoal is unlikely to be of any benefit (Browning and Curry, 1994). The blood gases, haemoglobin, liver function and osmolality (but see note below) should be monitored. Urinalysis including the presence of oxalate crystals is also recommended.

The airway must be protected. Aspiration has been reported in glycol ether poisoning (Buckhart and Donovan, 1998). Ventilation will be required in patients with severe CNS depression. Hypotension should be managed with IV fluids and dopamine or dobutamine if necessary.

Acidosis should be treated with sodium bicarbonate. If acidosis is refractory then haemodialysis should be considered. Antidotal therapy should be considered.

Glycol ethers and their alkoxyacetic acid metabolites produce a linear increase in plasma osmolality with increasing plasma concentration. However, the change in osmolality is small, only 3-12 mOsm/kg H2O in one study (Browning and Curry, 1992) and may not be clinically useful in cases of acute poisoning with glycol ethers (Lund et al., 1983; Browning and Curry, 1992). The normal osmolar gap is variable and may be 1-34 mOsm/kg H2O (Dorwart and Chalmers, 1975). In cases of acute poisoning where the osmolality has been measured it has been found to be 12 mOsm/kg H2O (Wermuth and Furbee, 1997), 1 mOsm/kg H2O (McKinney et al., 2000) and absent (Gijsenbergh et al., 1989).

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