oxalic acid
Summary
Oxalic acid is the toxic metabolite of ethylene glycol that precipitates with calcium to form calcium oxalate crystals, causing acute kidney injury, hypocalcemia, and neurologic symptoms.
Detail
Ethylene glycol is oxidized to oxalic acid, which precipitates with serum calcium forming calcium oxalate crystals that deposit in kidneys (acute tubular necrosis), heart, and brain. Poisoning progresses through CNS phase (6-12h), pulmonary phase (12-24h), and renal phase (24-72h). Diagnosis: high anion gap metabolic acidosis, elevated osmolar gap, envelope-shaped calcium oxalate crystals in urine. Treatment: fomepizole/ethanol, hydration, hemodialysis, IV calcium gluconate for hypocalcemia.
Sources
- First Aid for the USMLE Step 1
- Goldfrank's Toxicologic Emergencies
- Harrison's Principles of Internal Medicine
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