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Table 8 Final EXTRIP recommendations on the use of ECTR in ethylene glycol poisoning

From: Extracorporeal treatment for ethylene glycol poisoning: systematic review and recommendations from the EXTRIP workgroup

INDICATIONS*

EG Dose

 a. In patients presenting with EG poisoning, we recommend against ECTR based solely on the reported EG dose

Plasma EG concentration

 a. Fomepizole is used

   i. In patients presenting with EG poisoning, we suggest ECTR if EG concentration is > 50 mmol/L (> 310 mg/dL)

 b. Ethanol is used

   i. In patients presenting with EG poisoning, we recommend ECTR if EG concentration is > 50 mmol/L (> 310 mg/dL)

   ii. In patients presenting with EG poisoning, we suggest ECTR if EG concentration is 20–50 mmol/L (124–310 mg/dL)

 c. No antidote is available

   i. In patients presenting with EG poisoning, we recommend ECTR if EG concentration is > 10 mmol/L (> 62 mg/dL)

Osmol gap (calculated as measured osmolality − calculated osmolarity, in SI units and adjusted for ethanol) when there is evidence of EG exposure

 a. Fomepizole is used

   i. In patients presenting with EG poisoning, we suggest ECTR if the osmol gap is > 50

 b. Ethanol is used

   i. In patients presenting with EG poisoning, we recommend ECTR if the osmol gap is > 50

   ii. In patients presenting with EG poisoning, we suggest ECTR if the osmol gap is 20–50

 c. No antidote is available

   i. In patients presenting with EG poisoning, we recommend ECTR if the osmol gap is > 10

Plasma glycolate concentration

 a. In patients presenting with EG poisoning, we recommend ECTR if the glycolate concentration is > 12 mmol/L

 b. In patients presenting with EG poisoning, we suggest ECTR if the glycolate concentration is 8–12 mmol/L

Anion gap (calculated as Na+  + K+  − Cl  − HCO3) when there is evidence of EG exposure

 a. In patients presenting with EG poisoning, we recommend ECTR if the anion gap is > 27 mmol/L

 b. In patients presenting with EG poisoning, we suggest ECTR if the anion gap is 23–27 mmol/L

Clinical indications

 a. Coma

   i. In patients presenting with coma due to EG poisoning, we recommend ECTR

 b. Seizures

   i. In patients presenting with EG poisoning and seizures, we recommend ECTR

 c. Kidney Impairment

   i. In patients presenting with EG poisoning and CKD (eGFR < 45 mL/min/1.73m2), we suggest ECTR

   ii. In patients presenting with EG poisoning and AKI (KDIGO stage 2 or 3), we recommend ECTR

MODALITY

 a. In patients presenting with EG poisoning requiring ECTR, when all ECTR modalities are available, we recommend using intermittent hemodialysis rather than any other type of ECTR

 b. In patients presenting with EG poisoning requiring ECTR, we recommend using continuous kidney replacement therapy over other types of ECTR if intermittent hemodialysis is not available

CESSATION

 a. We recommend stopping ECTR when the anion gap (calculated as Na+  + K+  − Cl  − HCO3) is < 18 mmol/L

 b. We suggest stopping ECTR when the EG concentration is < 4 mmol/L (25 mg/dL)

 c. We suggest stopping ECTR when acid–base abnormalities are corrected

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  1. Bold text was inserted to highlight the result
  2. ECTR extracorporeal treatment, EG Ethylene glycol, CKD Chronic kidney disease, AKI Acute kidney injury, KDIGO Kidney Disease Improving Global Outcomes
  3. *If any of indication criteria fulfills a recommendation for ECTR, then ECTR should be performed regardless of the presence of other conditions