A 42-year-old man presented to the intensive care unit with respiratory and renal failure, nine days after admission to hospital with acute renal failure and a raised anion-gap acidosis. He went on to develop an acute, painful ascending motor and sensory neuropathy. Ethylene glycol toxicity was diagnosed on the basis of nerve conduction tests, a renal biopsy showing oxalate crystals, and retrospective analysis of admission blood tests. The case reviews diagnosis and treatment of ethylene glycol toxicity. It also raises the ethical dilemmas faced by staff treating patients who deny ingestion in the face of the evidence.
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