Correct!
5. All of the above.
Fomepizole or 4-methylpyrazole is indicated for use as an antidote in confirmed or suspected ethylene glycol or methanol poisoning (1). It may be used alone or in combination with hemodialysis. Fomepizole is a competitive inhibitor of the enzyme alcohol dehydrogenase found in the liver. This enzyme plays a key role in the metabolism of ethylene glycol and methanol. Ethylene glycol is first metabolized to glycolaldehyde by the enzyme alcohol dehydrogenase, which then undergoes further oxidation to glycolate, glyoxylate, and oxalate. It is glycolate and oxalate that are primarily responsible for the metabolic acidosis and renal damage that are seen in ethylene glycol poisoning. By competitively inhibiting the first enzyme in the metabolism of ethylene glycol fomepizole slows the production of the toxic metabolites.
In patients with ethylene glycol poisoning, the administration of pyridoxine and has been frequently advocated as an adjunctive therapy, because pyridoxine is a cofactor in the metabolism of glycolic acid to glycine. However, there are sparse data supporting any beneficial effect of such treatment.
The patient was treated with fomepizole, hemodialysis, pyridoxine, folate and thiamine and improved. He was extubated 24 hours after transfer and was awake and alert.
However, 30 hours after transfer he developed tachycardia to 150 beats/min, fever to 103ºF and hypotension. His chest x-ray and echocardiogram were negative.
Which of the following should be administered next? (Click on the correct answer to proceed to the next panel)