Successful treatment of late obstetric ethylene glycol intoxication with ethanol via the enteral route: a case report

Late obstetric ethylene glycol intoxication represents a diagnostic challenge for acute care physicians and an impending life threat with life-long implications for both the mother and the fetus. The metabolism of ethylene glycol to its toxic metabolites during late pregnancy is unpredictable due to maternal physiological changes. Namely, the hallmark signs and symptoms of ethylene glycol intoxication can mimic those of late pregnancy-related high blood pressure disorders, which makes it difficult to correctly diagnose the condition. Therefore, it is crucial to promptly recognize late obstetric ethylene glycol intoxication and initiate specific treatment, but evidence-based recommendations are not available to guide its most effective emergent treatment. We present our department's emergent management of late-obstetric ethylene glycol intoxication. The parturient was stabilized by inhibiting ethylene glycol metabolism, alongside general supportive care measures. The enhancement of its toxic metabolites was eliminated by administering ethanol via the enteral route, which progressively improved the parturient's clinical course and led to the on-term delivery of a healthy child. Our case shows the importance of a meticulous emergent assessment, prompt diagnosis, and carefully planned multidisciplinary treatment in the emergency department in improving outcomes after ethylene glycol intoxication in late pregnancy.