Honey, I drank some antifreeze

Home / Journal Club / Honey, I drank some antifreeze

A 30s M accidentally swallows some anti-freeze when he was siphoning it from a bottle.  What do we need to know in a history and physical?  What work-up is needed?

And yes, this is a tylenol overdose.


  • JBalbs

    Watch for progression of systemic symptoms:
    1) neurologic/GI- 30 min to 12 hours; nausea, vomiting, somnolence, altered mental status, ataxia, CNS depression, seizures
    2) cardiopulm- 12 to 36 hours; respiratory distress/tachypnea, arrhythmia (ie long QT), tachycardia, elevated blood pressure, heart failure
    3) renal- 24 to 72 hours; renal failure, hematuria, anuria, oliguria, renal tubular necrosis, flank pain due to crystal formation

    Definitely need labs. There will be a high anion gap metabolic acidosis.

  • pik

    Accidental ingestion? Likely no big deal.
    He came to the ED? Are there ulcerations or blisters in the oral mucosa? Wash out his mouth.
    Good way to absorb, but if not trying to get drunk or kill yourself, probly not bad. I’d bet there are a ton of folks who do this, maybe make a phone call to poison control and then don’t come to the ED.

    The “yes, it’s a Tylenol OD” is either an inside joke or is scary- if he’s actually trying to kill himself then he’s not to be trusted on the “sip” amt.

    As Balbs posts above, progression is vague bs Neuro, then GI, then serious Neuro, then Renal.

  • JBalbs

    Great point Pik. Also, I wonder if it was actually intentional (ie he drank 30 cc of 50/50 antifreeze), how much would the plasma/blood level be? Any thoughts on calculating serum concentration of this alcohol to determine if the level ingested is toxic or not?

    • CSun

      So I guess if the labs are down, are taking too long to post results, and/or calculating the osmolal gap intimidates you, you can perhaps calculate serum ethylene glycol concentration with pen and paper and starting with the the Volume of Distribution (Vd) of Ethylene Glycol.

      The Vd of ethylene glycol is referenced as 0.6-0.8L/kg body weight, which means the Vd of an “accidental” ingestion would be anywhere between 48L to 64L for me (assuming I’m 80kg and I was craving something sweet to drink).

      And if the DOSE of ethylene glycol I ingested is 30cc of antifreeze where ethylene glycol is 50/50 of that mixture then we go back to the good ol’ days of high school chem:

      50g/100ml = x/30ml
      x = 15g or 15,000mg

      And if Serum Concentration = Dose/Vd, then my serum concentration would be 15,000mg/anywhere between 48L to 64L or anywhere between 23.4mg/dL to 31.2mg/dL.


  • pik

    Biggest problem with utilizing either the serum osm or the calculated level/expected toxicity as a guide is that it depends when you stick him. The longer it goes, the lower the serum osm, but the sicker the pt. as the metabolites, acidosis, and sx appear. Bottom line. If you don’t trust the story, don’t let a calculated osm or level stop you from initiating treatment. Always, always, always listen to sx. If the pt. and the test disagree, the pt. is always right.

Leave a Reply