FPGEE for National Association of Boards of Pharmacy (NABP) Practice Exam

What is the appropriate first step to take in the event of ethylene glycol poisoning?

1. Administer activated charcoal

2. Initiate gastric lavage if levels are less than 20mg/dL

3. Start hemodialysis immediately

4. Give ethanol to the patient

The correct answer is: Initiate gastric lavage if levels are less than 20mg/dL

The appropriate first step in the event of ethylene glycol poisoning is to give ethanol to the patient. Ethanol acts as a competitive inhibitor of the enzyme alcohol dehydrogenase, which is responsible for the metabolism of ethylene glycol into its toxic metabolites. By administering ethanol, the conversion of ethylene glycol to harmful substances is prevented, allowing for safer management of the poisoning. In contrast, administering activated charcoal can be effective in certain poisonings, but it is not typically the first line of treatment for ethylene glycol due to the absorption kinetics and the timing of ingestion. Gastric lavage may be considered based on the timing and severity, but it is less commonly used as a primary intervention. Starting hemodialysis is a critical intervention in severe cases of ethylene glycol poisoning, especially when there are indications of significant metabolic acidosis or renal failure; however, it is not the immediate first step. Ethanol administration should be prioritized to stabilize the patient and prevent further toxin metabolism.