Here’s an antidote you should know about
When treating patients for ethylene glycol and methanol toxicity, the antidote Antizol (fomepizole) will give you a better option, ED experts say. (See clinical guideline for ethylene glycol poisoning, inserted in this issue.)
"The drug is a better treatment than ethanol, which has been the antidote used for several decades," according to Helen Zimmerman, MSN, CRNP, CEN, nurse practitioner at the Milton S. Hershey Medical Center in Hershey, PA. (See symptoms of ethlyene glycol and methanol toxicity, p. 118.)
When treated with ethanol, patients are often kept intoxicated for days while toxic alcohols are excreted out of their bodies, Zimmerman explains. "The new antidote is much safer than adding alcohol to the system," she says.
Intensive nursing care
Nursing care for the patient is also intensive with ethanol, notes Steve Weinman, RN, BSN, CEN, emergency department instructor at New York Weill Cornell Medical Center at New York Presbyterian Hospital in New York City. Admission to the intensive care unit for close observation, serial serum ethanol levels, and ethanol dosing (typically as a constant intravenous infusion) are necessary, he adds.
Also, blood alcohol levels must be taken frequently to make sure the range is between 100 and 130 mg/dL, Zimmerman notes. "With ethanol, you have to keep the blood alcohol between 100 and 130, which is legally drunk."
It’s difficult to keep blood alcohol in that narrow band," she acknowledges. "But if you go above that, the patient can aspirate."
Fomepizole (manufactured by Minnetonka, MN-based Orphan Medical) has several other advantages, including a slower rate of elimination, longer duration of action, a reasonable dosing schedule, and less potential for adverse affects, says Zimmerman.
Administer drug quickly
The drug should be given as soon as possible, says Zimmerman. If fomepizole is given before kidney failure occurs, metabolite accumulation is minimized, says Zimmerman. "The kidneys may then excrete ethylene glycol," she says.
The drug is costly, at approximately $1,000 per vial. Ethanol is relatively inexpensive with an average cost of less than $100 per patient, whereas fomepizole therapy may cost as much as $5,000 for loading dose and maintenance doses, depending on toxicity, notes Weinman. However, the cost is offset because the patient may not have to be admitted to the ICU for less severe poisonings, he adds.
For more information about the antidote for ethylene glycol and methanol poisoning, contact:
• Helen E. Zimmerman, MSN, CRNP, CEN, The Milton S. Hershey Medical Center, Department of Cardiology, H047, P.O. Box 850, Hershey, PA 17033-0850. Telephone: (717) 531-8521. Fax: (717) 531-7969. E-mail: [email protected].
• Steve Weinman, RN, BSN, CEN, Emergency Department, New York Weill Cornell Medical Center at New York Presbyterian Hospital, 525 E. 68th St., Box 174, New York, NY 10021. Telephone: (212) 746-2914. Fax: (212) 746-1490. E-mail: [email protected].
For information about Fomepizole, contact:
• Orphan Medical, 13911 Ridgedale Drive, Suite 250, Minnetonka, MN 55305. For questions about the product, call Professional Services. Telephone: (888) 867-7426. Fax: (952) 541-9209. E-mail: [email protected]. Web site: www.orphan.com.
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