Abstracts

Rationale: OBJECTIVE: We report a case of a patient with reversible alpha coma following ethylene glycol poisoning. Methods: BACKGROUND: Alpha coma or alpha coma pattern is an EEG pattern consisting of alpha pattern in unresponsive patients and does not attenuate to stimuli. It is most commonly associated with respiratory and cardiac arrest and are most often non-reversible. Other causes include hypoxia, toxic- metabolic abnormalities, and head trauma. We report a case of alpha coma that has not, to our knowledge, heretofore been described. Results: CASE: A 55 year old male with history of insomnia presented to the emergency department after being found unresponsive. His exam was notable for comatose state with intact pupils but absent vestibulo- oculoreflexes. He did not respond to noxious stimuli and was hypotonic. Reflexes were absent. He was tachycardic and tachypneic. Laboratory testing revealed ethylene glycol level >150 mg/dL, severe metabolic acidosis, and acute renal insufficiency with creatinine 4.15 mg/dL. A non-contrast head CT did not demonstrate acute intracranial abnormality. Continuous EEG monitoring demonstrated non-reactive alpha coma pattern. He was treated with fomepizole and dialysis. Shortly following initiation of treatment his EEG pattern improved and the patient improved to baseline within 24hours of admission. Conclusions: DISCUSSION: To the extent of our knowledge, we report a novel cause of alpha coma related to ethylene glycol poisoning. Although many causes are irreversible and suggests a grave prognosis, we bring to light a reversible cause of alpha coma. Physicians should be aware of this toxic syndrome and associated EEG pattern as it is amenable to treatment. Funding: none