{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T10:44:30Z","timestamp":1764585870282,"version":"3.46.0"},"reference-count":13,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,10,24]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:p>This case report describes a male in his early 40s presenting with severe ethylene glycol (EG) poisoning from antifreeze ingestion, marked by profound metabolic acidosis, hyperkalaemia and multi-organ failure. The patient was found unconscious in the garage with shallow breathing and hypothermia, progressing to critical illness despite aggressive resuscitative measures. Diagnostic evaluations revealed high anion gap metabolic acidosis, elevated lactate, hyperkalaemia and a high osmolal gap, confirmed to be due to EG toxicity. Immediate interventions included continuous renal replacement therapy, mechanical ventilation and supportive care, alongside bicarbonate therapy and broad-spectrum antibiotics. However, the patient deteriorated rapidly, developing fixed dilated pupils, cerebral oedema and eventual death on the third day of admission. This case highlights the diagnostic and therapeutic challenges of managing severe toxic EG poisoning in critically ill patients and underscores the importance of early recognition and intervention to improve outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2025-266568","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T02:35:18Z","timestamp":1763001318000},"page":"e266568","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Severe metabolic acidosis with elevated lactate and multi-organ dysfunction secondary to ethylene glycol toxicity"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4568-6664","authenticated-orcid":false,"given":"Shahwaz","family":"Ahmad","sequence":"first","affiliation":[{"name":"Anesthesia and Critical Care, Galway University Hospitals, Galway, County Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6270-4347","authenticated-orcid":false,"given":"Ahmad","family":"Hassan","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4779-7305","authenticated-orcid":false,"given":"Sara","family":"Rashid","sequence":"additional","affiliation":[{"name":"Critical Care, Portiuncula Hospital Ballinasloe, Galway, County Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinod","family":"Sudhir","sequence":"additional","affiliation":[{"name":"Anesthesia and Critical Care, Portiuncula University Hospital, Ballinasloe, Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"2025120102402136000_18.11.e266568.1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s41935-021-00244-4","article-title":"Suicide by ethylene glycol\/brake oil poisoning\u2014a case report","volume":"11","author":"Vadysinghe","year":"2021","journal-title":"Egypt J Forensic Sci"},{"key":"2025120102402136000_18.11.e266568.2","doi-asserted-by":"publisher","DOI":"10.1177\/0004563213506697"},{"key":"2025120102402136000_18.11.e266568.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0143044","article-title":"Clinical Features of Reported Ethylene Glycol Exposures in the United States","volume":"10","author":"Jobson","year":"2015","journal-title":"PLoS ONE"},{"key":"2025120102402136000_18.11.e266568.4","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2008.12.019"},{"key":"2025120102402136000_18.11.e266568.5","first-page":"807","article-title":"Treatment of ethylene glycol poisoning","volume":"66","author":"Scalley","year":"2002","journal-title":"Am Fam Physician"},{"key":"2025120102402136000_18.11.e266568.6","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2018-224243","article-title":"Lactate gap as a tool in identifying ethylene glycol poisoning","volume":"2018","author":"Sagar","year":"2018","journal-title":"BMJ Case Rep"},{"key":"2025120102402136000_18.11.e266568.7","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-022-04227-2","article-title":"Extracorporeal treatment for ethylene glycol poisoning: systematic review and recommendations from the EXTRIP workgroup","volume":"27","author":"Ghannoum","year":"2023","journal-title":"Crit Care"},{"key":"2025120102402136000_18.11.e266568.8","unstructured":"Toxicological Profile for Ethylene Glycol. 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