This is the current release of the guideline.

Grades of recommendation (A-D, Z) and levels of evidence (1a-6) are defined at the end of the "Major Recommendations" field.

Note: Recommendations are in chronological order of likely clinical use. The grade of the recommendation is in parentheses.

1. Patients with exposure due to suspected self-harm, misuse, or potentially malicious administration should be referred to an emergency department immediately regardless of the doses reported (Grade D).
2. Patients with inhalation exposures will not develop systemic toxicity and can be managed out-of-hospital if asymptomatic (Grade B). Patients with clinically significant mucous membrane irritation should be referred for evaluation (Grade D).
3. Decontamination of dermal exposures should include routine cleansing with mild soap and water. Removal of contact lenses and immediate irrigation with room temperature tap water is recommended for ocular exposures. All patients with symptoms of eye injury should be referred for an ophthalmologic exam (Grade D).
4. Patients with symptoms of ethylene glycol poisoning (e.g., vomiting, slurred speech, ataxia, altered mental status) should be referred immediately for evaluation regardless of the reported doses (Grade C).
5. The absence of symptoms shortly after ingestion does not exclude a potentially toxic dose and should not be used as a triage criterion (Grade C).
6. Adults who ingest a "swallow" (10-30 mL), children who ingest more than a witnessed taste or lick, or if the amount is unknown of most ethylene glycol products should be referred immediately for evaluation. The potential toxic volume of very dilute solutions (e.g., product concentration known to be <20%) is larger and can be estimated by the formula (Formula 2) in the original guideline. If the concentration of the product is not known, it should be assumed to be a concentrated (>20%) product (Grade C).
7. A witnessed "taste or lick" only in a child, or an adult who unintentionally drinks and then expectorates all of a concentrated product without swallowing, does not need referral (Grade C).
8. Referral is not needed if it has been more than 24 hours since a potentially toxic unintentional exposure, the patient has been asymptomatic, and no alcohol was co-ingested (Grade D).
9. Gastrointestinal decontamination in the out-of-hospital setting with ipecac syrup, gastric lavage, or activated charcoal is not recommended. Transportation to an emergency department should not be delayed for any decontamination procedures (Grade D).
10. Patients meeting referral criteria should be evaluated at a hospital emergency department rather than a clinic. A facility that can quickly obtain an ethylene glycol serum concentration and has alcohol or fomepizole therapy available is preferred. This referral should be guided by local poison center procedures and community resources (Grade D).
11. The administration of alcohol, fomepizole, thiamine, or pyridoxine is not recommended in the out-of-hospital setting (Grade D).

Definitions:

Grades of Recommendation and Levels of Evidence

An algorithm is provided in Appendix 4 of the original guideline document for triage of patients with ethylene glycol ingestions.

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations"). The strength of evidence for this guideline is limited to case series, case reports (level 4), one cohort inhalation study (level 2b) and one case-control study of ingestion (level 3b).

Not applicable: The guideline was not adapted from another source.

2005 May 3

American Association of Poison Control Centers - Professional Association

Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services

Not stated

Primary Authors: E. Martin Caravati, M.D., M.P.H.; Andrew R. Erdman, M.D.; Gwenn Christianson, M.S.N.; Anthony S. Manoguerra, Pharm.D.; Lisa L. Booze, Pharm.D.; Alan D. Woolf, M.D., M.P.H.; Kent R. Olson. M.D.; Peter A. Chyka, Pharm.D.; Elizabeth J. Scharman, Pharm.D.; Paul M. Wax, M.D.; Daniel C. Keyes, M.D., M.P.H.; William G. Troutman, Pharm.D.

Panel Members: Lisa L. Booze, PharmD, Certified Specialist in Poison Information, Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, Maryland; E. Martin Caravati, MD, MPH, FACMT, FACEP, Professor of Surgery (Emergency Medicine), University of Utah, Medical Director, Utah Poison Center, Salt Lake City, Utah; Gwenn Christianson, RN, MSN, Certified Specialist in Poison Information, Indiana Poison Center, Indianapolis, Indiana; Peter A. Chyka, PharmD. FAACT, DABAT, Professor, Department of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee; Daniel C. Keyes, MD, MPH, Medical Director, Pine Bluff Chemical Demilitarization Facility, Associate Professor, Southwestern Toxicology Training Program, Dallas, Texas; Anthony S. Manoguerra, PharmD, DABAT, FAACT, Professor of Clinical Pharmacy and Associate Dean, School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, Former Director, California Poison Control System, San Diego Division, San Diego, California; Kent R. Olson, MD, FACEP, FAACT, FACMT, Medical Director, California Poison Control System, San Francisco Division, Clinical Professor of Medicine & Pharmacy, University of California, San Francisco, San Francisco, California; Elizabeth J. Scharman, PharmD, DABAT, BCPS, FAACT, Director, West Virginia Poison Center, Professor, West Virginia University School of Pharmacy, Dept. Clinical Pharmacy, Charleston, West Virginia; Paul M. Wax, MD, FACMT, Managing Director, Banner Poison Center, Professor of Clinical Emergency Medicine, University of Arizona School of Medicine, Phoenix, Arizona; Alan D. Woolf, MD, MPH, FACMT, Director, Program in Environmental Medicine, Children's Hospital, Boston, Associate Professor of Pediatrics, Harvard Medical School, Boston, Massachusetts

There are no potential conflicts of interest reported by the expert consensus panel or project staff regarding this guideline.

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI on October 28, 2005. The information was verified by the guideline developer on November 28, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.