Severe metabolic acidosis with elevated lactate and multi-organ dysfunction secondary to ethylene glycol toxicity

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.