Ethylene glycol poisoning has it all. It is a medical emergency with well-defined clinical stages resulting from an intriguing pathophysiologic process that can be explained by applied biochemistry.1 The morbidity and mortality associated with untreated ethylene glycol poisoning are high, but with early diagnosis and effective treatment, the mortality is close to nil.1,2 Therefore, cases of ethylene glycol poisoning are regularly studied as clinicopathological exercises by medical students and residents.3 In my experience, it is hard to find a more challenging type of case to discuss.Ethylene glycol is the chief component of antifreeze fluid. When it is ingested, . . .