Ethylene glycol intoxication, suicidal as well as accidental, belongs to serious, immediately life-threatening poisonings, which can however be cured even in the most severe cases (provided early recognition and correct treatment), including the restoration of renal function to the original state. Ethylene glycol is most notably present in anti-freeze cooling liquids for vehicles (such as Fridex). Consumption of 100-150 ml of such a solution is considered a lethal dose in humans. follows Oral ingestion is followed by rapid absorption. Metabolic decomposition takes place predominantly in the liver by way of alcohol dehydrogenase, to glycoaldehyde, which is further metabolised to glycolic acid and oxalic acid. The clinical aspect is dominated by acute renal failure which is caused by acute tubular necrosis. Toxicological examination including an assessment of ethylene glycol levels in both blood and urine, with prognostic relevance, is indispensable to diagnostics of the poisoning as well as from the standpoint of differential diagnostics. Therapeutic measures include gastric lavage within one hour of ingestion and administration of activated charcoal. Administration of ethanol and fomepizole, compounds that bind alcohol dehydrogenase and thus prevent the conversion of ethylene glycol to its toxic metabolites, is considered valid causal treatment with simultaneous early institution of hemodialysis (even in cases of hitherto intact renal function). As fomepizole is currently not available in the Czech republic, ethanol remains the only antidote. Therapy further includes correction of metabolic acidosis by way of bicarbonates, and intravenous application of thiamine and pyridoxine. Therapy of such a grave condition must entail infirmary care provided by professional nurses as a necessary complement. The nurse serves their function in securing the patient's airways, connecting the patient to mechanical ventilation, monitoring physiological functions, assistance with invasive entry, as well as conducting sample extractions, assuring proper hygiene, the prevention of decubitus ulcers etc. It has been the aim of an extensive effort during my analysis of this topic to collate an up-to-date summary of practical knowledge on ethylene glycol intoxication, as well as subsequent therapeutic options for such patients, based on collected information and available source material. This final thesis, entitled "Approach and Options for Nurses in Therapy of Ethylene Glycol-intoxicated Patients" has been created relying on a body of purely theoretical Czech and foreign sources. To attain awareness of the current state of medical sciences described on the following pages, many professional and scientific publications, books as well as journals and websites of registered professional societies had to be studied. The aim of a detailed inspection of such an extensive body of data has been to provide relevant findings based on the facts determined. The accumulated information is further specified in particular sections. The first deal with intoxication, elimination and first aid in the pre-hospitalization phase from a broader perspective. Without these elementary notes the thesis as a whole would lack in conclusiveness. From this section the thesis fluidly continues with ethylene glycol intoxication itself, its treatment and all the way to the role of the nurse including particular therapeutic measures. These sections contain specific recommendations issuing from news and cutting-edge research on ethylene glycol poisonings.
| Identifer | oai:union.ndltd.org:nusl.cz/oai:invenio.nusl.cz:200584 |
| Date | January 2015 |
| Creators | KMETKOVÁ, Monika |
| Source Sets | Czech ETDs |
| Language | Czech |
| Detected Language | English |
| Type | info:eu-repo/semantics/masterThesis |
| Rights | info:eu-repo/semantics/restrictedAccess |
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