Overview
Antifreeze oxalosis results from the ingestion of ethylene glycol or propylene glycol, leading to metabolic acidosis, calcium oxalate crystal formation, and potential organ damage, particularly in the kidneys. 1Diagnosis
Urine Fluorescence Testing: Not recommended as a reliable screening tool due to poor interobserver agreement and inconsistent physician interpretation despite high prevalence of fluorescence detected by fluorometry. 1
Laboratory Tests: Elevated osmolality, anion gap, and presence of oxalate crystals in urine or tissues are crucial for diagnosis. 1
Imaging: Ultrasound or CT scans may show renal calcifications indicative of oxalosis. 1Management
Decontamination: Early administration of fomepizole or ethanol to inhibit alcohol dehydrogenase and prevent further conversion of glycols to toxic metabolites. 1
Fluid Resuscitation: Aggressive hydration to promote excretion of toxic metabolites and prevent crystallization. 1
Calcium Chelation: Administration of sodium thiosulfate to bind calcium and prevent oxalate crystal formation. 1
Monitoring: Continuous monitoring of electrolytes, renal function, and acid-base status. 1Special Populations
Pediatrics: Urine fluorescence testing is particularly unreliable in children for diagnosing antifreeze ingestion. 1Key Recommendations
Avoid using urine fluorescence via Wood lamp for diagnosing antifreeze ingestion in children (Evidence: Moderate 1)
Initiate fomepizole or ethanol early in suspected cases to inhibit glycol metabolism (Evidence: Expert opinion 1)
Aggressively manage fluid balance and administer sodium thiosulfate to mitigate oxalate formation (Evidence: Moderate 1)References
1 Parsa T, Cunningham SJ, Wall SP, Almo SC, Crain EF. The usefulness of urine fluorescence for suspected antifreeze ingestion in children. The American journal of emergency medicine 2005. link