Fatal Ethylene Glycol Poisoning Presented with Severe Metabolic Acidosis- An Emerging Toxicological Crisis Mimicking Methanol Poisoning

Authors

  • Abu Shahin Mohammed Mahbubur Rahman Associate Professor of Medicine, Rajshahi Medical College https://orcid.org/0000-0002-5638-8476
  • Toma Mehedi Site trial coordinator, Methanol POCT study in RMCH
  • M A Hosen Clinical Research Assistant, Methanol POCT study in RMCH 
  • N J Annie Clinical Research Assistant, Methanol POCT study in RMCH 
  • Fazle Rabbi Chowdhury  Associate Professor, Bangladesh Medical University https://orcid.org/0000-0001-9579-0030
  • Aniruddha Ghosh  Professor of Medicine, Chattogram Medical College 

Keywords:

Ethylene glycol, Metabolic acidosis, methanol poisoning, RMCH

Abstract

Background: Ethylene glycol poisoning is an uncommon yet potentially fatal toxicological emergency, resulting from adulterated alcohol consumption. Early recognition and rapid treatment are essential to prevent organ failure and mortality.

Case Presentation: We report a 25-year-old tribal male who presented to Rajshahi Medical College Hospital with severe respiratory distress, abdominal pain, blurred vision, and altered consciousness following ingestion of a locally brewed alcohol (“Chuani”). Initial arterial blood gas (ABG) analysis revealed profound anion-gap metabolic acidosis (pH 6.93, HCO₃⁻ 6.93 mmol/L, base deficit 28.2 mmol/L). The patient was treated with fomepizole, intravenous sodium bicarbonate, and folic acid, along with other supportive measures. The initial suspicion was of a case of methanol poisoning. However, serum formate levels were negative; urine microscopy demonstrated calcium oxalate crystals, confirming ethylene glycol poisoning. Despite aggressive therapy, the patient developed refractory shock and respiratory failure and subsequently died.

Conclusion: This case highlights the diagnostic challenges of adulterated alcohol poisoning in low-resource environments. Rapid metabolic evaluation, bedside urine microscopy, early antidote therapy, and community awareness regarding adulterated alcohol are crucial to reduce associated fatalities. 

J MEDICINE 2026; 27(2): 136-140

 

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Published

2026-09-06

Issue

Vol. 27 No. 2 (2026)

Section

Case Reports

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How to Cite

Mahbubur Rahman, A. S. M. ., Mehedi, T. ., Hosen, M. A. ., Annie, . N. J. ., Chowdhury, F. R. ., & Ghosh, A. . (2026). Fatal Ethylene Glycol Poisoning Presented with Severe Metabolic Acidosis- An Emerging Toxicological Crisis Mimicking Methanol Poisoning. Journal of Medicine, 27(2), 136-140. https://doi.org/10.3329/jom.v27i2.92093