American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is NOT a treatment component for ethylene glycol overdose?

1. Fomepizole

2. Hemodialysis

3. Oral sodium bicarbonate

4. Intravenous sodium bicarbonate

The correct answer is: Oral sodium bicarbonate

In the management of ethylene glycol overdose, the primary treatment components include fomepizole, which acts as a competitive inhibitor of the enzyme alcohol dehydrogenase, thus preventing the metabolism of ethylene glycol to its toxic metabolites. Hemodialysis is also an essential treatment as it effectively removes ethylene glycol and its metabolites from the bloodstream, especially in severe cases or when renal function is compromised. Intravenous sodium bicarbonate can be used in specific scenarios to correct metabolic acidosis that may result from the overdose. However, oral sodium bicarbonate is not a recognized treatment component for ethylene glycol poisoning. This is primarily due to the fact that the oral route may not provide timely or adequate absorption when urgent correction of acidosis is required. Additionally, given the potential for severe neurological impairment or the need for more aggressive interventions, oral sodium bicarbonate is not considered effective in this acute setting. Thus, it is not routinely employed as part of the treatment strategy for ethylene glycol overdose.