A 39-year-old man, BB, presented to the emergency room unconscious after drinking a homemade snow globe containing ethylene glycol, a toxic chemical found in antifreeze. BB had a history of alcohol dependence, but had been sober for 10 years until he relapsed after his divorce. He ran out of alcohol and, experiencing withdrawal symptoms, drank the snow globe, leading to severe consequences.
The ethylene glycol was metabolized into glycolic acid, glyoxylic acid, and oxalic acid, which contributed to high anion gap metabolic acidosis. The body tried to eliminate the excess anions by increasing breathing rate, but the kidneys were unable to clear them, leading to kidney failure.
When BB presented to the hospital, he was in kidney failure, with high levels of creatinine and inflammation in his blood. A CT scan showed possible kidney infection, and he was started on dialysis and antibiotics. However, it wasn't until six days later that BB revealed he might have consumed a snow globe, and his son showed a picture of him holding an empty snow globe.
Further testing revealed tiny crystals had formed in BB's kidneys, causing damage and inflammation. The crystals were composed of calcium oxalate, a result of the ethylene glycol metabolism. The calcium oxalate crystals caused kidney damage, leading to kidney failure, and also caused nerve damage, leaving BB unable to walk for 10 weeks.
If BB had presented to the hospital earlier and the doctors had known about the ethylene glycol ingestion, the treatment would have been to stop the liver from breaking down the toxin, possibly by administering ethanol. However, this was not done in time, and BB's kidneys were severely damaged, requiring ongoing dialysis.
Here are the key facts from the text:
1. BB, a 39-year-old man, presented to the emergency room unconscious.
2. He had a history of alcohol dependence but had been sober for 10 years.
3. BB's son found him on the floor two days earlier but didn't think anything was wrong.
4. BB had been drinking again after his divorce and had run out of alcohol due to a curfew.
5. He drank a snow globe, which contained an unknown chemical.
6. BB's blood test showed high anion gap metabolic acidosis and kidney failure.
7. His kidneys were not clearing waste products, including creatinine.
8. BB's urine sample showed blood and high levels of oxalate.
9. An ultrasound and CT scan showed damage to his kidneys.
10. BB was started on dialysis and antibiotics, but his condition did not improve.
11. A biopsy of his kidneys showed calcium oxalate crystals and dead tissue.
12. The snow globe contained ethylene glycol, which is toxic to humans.
13. Ethylene glycol is broken down by the liver into glycolic acid, glyoxylic acid, and oxalic acid, all of which have negative charges.
14. The body tries to eliminate these anions by increasing breathing rate and eliminating bicarbonate.
15. Calcium ions bind to oxalate, forming solid crystals that cannot dissolve in water.
16. These crystals damaged BB's kidneys and caused inflammation.
17. If treated early, the cure for ethylene glycol poisoning would have been to stop the liver from breaking it down by giving BB ethanol.
18. However, this treatment was not done in time, and BB's kidneys are now permanently damaged.
19. He will likely need dialysis for the foreseeable future.
20. BB experienced nerve damage due to the calcium oxalate crystals and took 10 weeks to start walking again.