J Emerg Med
-
Case Reports
Symptomatic Diethylene Glycol Ingestion Successfully Treated with Fomepizole Monotherapy.
Diethylene glycol (DEG) is an industrial solvent with many uses, including brake fluids. It has also caused mass poisonings after use as an inappropriate substitute for propylene glycol or glycerin, though individual ingestions are rare. Like other toxic alcohols, DEG is metabolized by alcohol dehydrogenase and aldehyde dehydrogenase, with toxicity likely mediated by the resulting metabolites. Fomepizole, an alcohol dehydrogenase inhibitor, is used to prevent metabolite formation with other toxic alcohol exposures. Fomepizole is recommended for DEG poisoning, though supporting clinical evidence is limited. ⋯ A 31-year-old man presented after ingestion of DEG-containing brake fluid and hydrocarbon-containing "octane booster." He was noted to be clinically intoxicated, with a mildly elevated anion gap metabolic acidosis and no osmolar gap. DEG level was later found to be elevated, consistent with his ingestion. He was treated with fomepizole alone, with resolution of metabolic acidosis and clinical findings over the next 2 days. No delayed neurologic sequelae were present at 52-day follow-up. Our case provides additional evidence supporting the use of fomepizole for DEG poisoning. Consistent with other toxic alcohols, DEG poisoning, especially early presentations, may benefit from empiric fomepizole administration. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: DEG poisoning is potentially life threatening, but treatable if identified early. An ingestion can be toxic despite a normal osmolar gap, leading to false reassurance. Finally, it is rare, so emergency physicians must be made aware of its potential dangers.
-
Case Reports
Severe Vertebral Body Fracture-Dislocation as a Result of Chest Compressions: A Case Report.
Although high-quality chest compressions are an essential, lifesaving component of cardiopulmonary resuscitation, injuries are common with both manual and mechanical chest compressions. ⋯ We discuss the case of a 77-year-old woman who sustained thoracic vertebral fractures after cardiopulmonary resuscitation involving both manual and mechanical chest compressions. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Routine post-cardiac arrest care should include evaluation for chest compression-related injury. If a patient has back pain, focal vertebral tenderness, or paraplegia after chest compressions, imaging to evaluate for vertebral fracture should be performed. If unable to assess for back pain or tenderness, consider imaging to evaluate for vertebral fracture in patients with kyphosis or osteopenia, as these patients are at higher risk for chest compression vertebral injury.