A client with suspected antifreeze ingestion has an anion-gap metabolic acidosis, an increased osmolar gap, and calcium oxalate crystals in the urine. Which action is the priority?
1Delay poison-center consultation until renal failure confirms significant poisoning.
2Administer oral calcium to bind ethylene glycol and correct the metabolic acidosis.
3Administer acetylcysteine because it prevents toxic-alcohol metabolite formation.
4Start prescribed fomepizole now and prepare for hemodialysis assessment.✓ Correct answer
Explanation
The findings support ethylene glycol poisoning. Fomepizole should begin on suspicion while the need for hemodialysis and correction of metabolic complications is assessed.
Why this is correct Fomepizole blocks alcohol dehydrogenase and limits formation of toxic metabolites. The label supports immediate treatment based on history, gaps, acidosis, visual findings, crystals, or a documented concentration.
Easy analogy or mental picture Close the metabolic factory before it converts antifreeze into kidney-damaging acids.
Memory hook Osmolar gap plus acidosis and crystals: fomepizole now.
NCLEX decision rule Do not wait for confirmatory injury when the toxic pattern supports time-sensitive antidote therapy.
Why the other choices are wrong Calcium alone and acetylcysteine do not block toxic-alcohol metabolism, and waiting permits more metabolite formation.
References
1DailyMed: Fomepizole InjectionImmediate treatment for suspected ethylene glycol or methanol poisoning and dialysis coordination