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Antifreeze (Ethylene Glycol) Skin Exposure: Emergency Decontamination & Toxicity

Ethylene glycol (antifreeze) skin exposure requires immediate decontamination. While dermal absorption is slower than ingestion, systemic toxicity can occur with prolonged contact or large surface area exposure.

Immediate Decontamination (First 10 Minutes)

  1. Remove ALL contaminated clothing, jewelry, shoes — bag for disposal
  2. Flush with copious lukewarm water ≥15 minutes
    • Shower ideal; avoid hot water (increases absorption)
    • Gentle soap if available; avoid aggressive scrubbing
  3. Irrigate eyes if splash exposure (15 min, eyelids held open)
  4. Don't apply ointments, oils, or neutralizing agents — may trap chemical

Toxicokinetics & Systemic Risk

  • Dermal absorption: ~1-5% of applied dose (vs. ~80% oral)
  • Risk factors for systemic toxicity: Large BSA, prolonged contact (>1 hr), occlusive clothing, damaged skin, concentrated product
  • Metabolism: Alcohol dehydrogenase → glycolic acid (acidosis) → oxalic acid (calcium oxalate crystals → renal failure)

Clinical Monitoring (If Significant Exposure)

  • Baseline & serial: BMP (Ca²⁺, creatinine, electrolytes), ABG/VBG, osmolal gap, anion gap, lactate, EG level if available
  • Urinalysis: Calcium oxalate crystalluria (envelope-shaped, bipyramidal)
  • Observation period: 6-12 hours minimum if >palm-sized exposure or delayed decon

Antidotal Therapy (If Systemic Toxicity Confirmed/Suspected)

  • Fomepizole (Antizol®): ADH inhibitor — 15 mg/kg IV load, then 10 mg/kg q12h (adjust for dialysis)
  • Ethanol (alternative): Competitive ADH inhibition — complex dosing, ICU monitoring required
  • Hemodialysis: Indicated for severe acidosis (pH <7.3), renal failure, EG level >50 mg/dL, refractory electrolyte disturbances
  • Thiamine 100mg IV + Pyridoxine 50mg IV: Cofactors for alternative metabolism
  • Folic acid 1mg IV: Enhances formate metabolism

When to Seek Emergency Care

  • Any systemic symptoms: nausea, vomiting, CNS depression, ataxia, seizures
  • Large surface area exposure (>10% BSA)
  • Delayed decontamination (>30 min)
  • Pediatric, elderly, or comorbid patients
  • Uncertainty about exposure magnitude

Poison Control (US): 1-800-222-1222 — call immediately for exposure-specific guidance.

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