A 47-year-old ex-nurse presented to the emergency department having consumed an unknown quantity of antifreeze. She was found to have a high level of ethylene glycol (the toxic component of antifreeze) in her bloodstream. Treatment is with either fomepizole or ethanol. She was treated with a loading dose of 2.5 mL/kg followed by 0.58 mL/kg/h of oral ethanol, equating to a maintenance dose of 35 mL of whisky every hour. She was placed on the gastroenterology ward next to two alcoholics recovering from acute withdrawal. It is important to appreciate the potential difficulties posed by scenarios of this type in order to provide optimum care both for the patient and those situated on the ward in the immediate vicinity. There is a requirement to compare the efficacies of fomepizole and ethanol therapy in the UK in order for a decision to be made on the most cost-effective first-line treatment.
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