Abstract: SA-PO0329
Fulminant Dual-Hit Oxalate Nephropathy from Teakwood Cleaner Ingestion
Session Information
- AKI: Case Reports - Drug/Toxin Injury, Crystals, Obstruction, and Unusual Presentations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Kumar, Sameet, University of Florida, Gainesville, Florida, United States
- Suman, Fnu, Richmond University Medical Center, New York, New York, United States
- Ruchi, Rupam, University of Florida, Gainesville, Florida, United States
- Pramod, Sheena, University of Florida, Gainesville, Florida, United States
Introduction
Oxalate nephropathy from household product ingestion is exceptionally rare. Teakwood cleaners can contain both oxalic acid and ethylene glycol or glycolic acid, creating a “dual-hit” oxalate burden: preformed oxalic acid causes immediate crystal deposition, while ethylene glycol is metabolized hepatically to additional oxalate.Over 50% of patients with oxalate nephropathy progress to kidney failure within one month and over 67% may remain dialysis dependent highlighting the need for early recognition.
Case Description
A 68-year-old male with major depressive disorder presented after suicidal ingestion of ~8 oz of teakwood cleaner. On admission, serum creatinine was 1.63 mg/dL (baseline 0.8 mg/dL) with a normal osmolar gap and anion gap of 14. Lactic acid of 2.7mmol/l (elevated). Esophagogastroduodenoscopy revealed severe caustic injury. Urine microscopy showed abundant envelope-shaped (calcium oxalate dihydrate) and dumbbell-shaped (calcium oxalate monohydrate) crystals with renal tubular epithelial cells, suggesting acute oxalate nephropathy. Despite aggressive intravenous fluids, creatinine rose to 4.7 mg/dL within 18 hours with oliguria, necessitating urgent intermittent hemodialysis. The patient remained dialysis dependent on Day 15 at the time of discharge.
Discussion
This case illustrates fulminant dual-mechanism oxalate nephropathy causing rapid AKI refractory to volume resuscitation. Concurrent caustic gastrointestinal injury likely exacerbated renal injury via volume depletion. Urine microscopy enabled prompt diagnosis, guiding timely nephrology intervention. Ingestions of products containing both oxalic acid and ethylene glycol may not be mitigated by fomepizole alone, emphasizing early renal replacement therapy. Increased production of lactic acid can result from exposure to the metabolites of ethylene glycol, but spurious increments in blood lactate may also occur due to interference of glycolate with the lactate measurement by point-of-care instruments.