ethylene glycol poisoning

EMERGENCY: Antifreeze (ethylene glycol) is highly toxic – contact your vet immediately if you think your pet has been exposed to it. Introduction. Ingestion of EG may cause serious poisoning. [1] Early symptoms include intoxication, vomiting and abdominal pain. Most ethylene glycol poisonings occur due to the ingestion of antifreeze. Ethylene glycol is a toxic, colorless, odorless, almost nonvolatile liquid with a sweet taste that is sometimes accidentally consumed by children and animals due to its sweetness. Ethylene glycol poisoning was considered in this patient because the toxicology screen detected ethylene glycol and several of the key diagnostic features were present: cardiorespiratory compromise, increased anion gap metabolic acidosis, increased osmolal gap, renal insufficiency, and crystalluria. [1] Toxicity and death may occur after drinking even a small amount. Purssell RA, Pudek M, Brubacher J, Abu-Laban RB. Ethylene glycol poisoning can present a diagnostic challenge in the emergency unit. While one can miss an osmolal gap by looking for one too late in this poisoning, one can miss an anion gap by looking too early. ethylene glycol poisoning (Tables 1 &2) including vomiting, haematemesis, coma, convulsions, oph-thalmoplegia, tachycardia, tachypnoea, pulmonary oedema and acute renal damage. A breathing machine (respirator) may be needed. ETHYLENE GLYCOL L'éthylène glycol (1,2-éthanediol) est un diol issu de la famille des hydrocarbures aliphatiques saturés, très largement utilisés dans l'industrie (antigel, explosifs, plastiques, agent de synthèse…). Ethylene glycol poisoning through ingestion can cause noncardiogenic pulmonary edema and ARDS. Ethylene Glycol Poisoning and Hyperglycemia A. R. Kunnummal Madathodi et al. The major factor prompting us to consider a toxicological cause for seizures in this patient, was the severe HAGMA. Gabow PA et al (1986) Organic acids in ethylene glycol intoxication. The issue is when we can expect to see this elevation in anion gap. drunk: automotive antifreeze, solvent, polish, paints, cosmetics, brake fluid, car wash fluid. Treatment of ethylene glycol poisoning with intravenous 4-methylpyrazole. The relevant pharmacokinetics are as follows: Ethylene glycol and methanol are both readily absorbed from the gut (e.g. Sadly, antifreeze poisoning is often fatal unless it's treated extremely quickly. Human studies have shown no link … A breathing machine (respirator) may be needed. Children may be exposed by accidental ingestion caused by decantation of EG to unlabeled bottles. 1. Ethylene glycol poisoning is caused by the ingestion of ethylene glycol, the primary ingredient in automotive antifreeze. 13, n o 10, octobre 1985, p. 872–3 [ lien PMID , lien DOI ] ↑ Amathieu R, Merouani M, Borron SW, Lapostolle F, Smail N, Adnet F, « Prehospital diagnosis of massive ethylene glycol poisoning and use of an early antidote », dans Resuscitation , vol. (en) Brent J, « Current management of ethylene glycol poisoning », Drugs, vol. It can be found in: Antifreeze Parry MF, Wallach R. PMID: 4834513 [PubMed - indexed for MEDLINE] MeSH Terms. Davis DP et al (1997) Ethylene glycol poisoning: case report of a record-high level and a review. A urine sample was sent for microscopy and showed multiple calcium oxalate monohydrate (COM) crystals, which supported the clinical suspicion of ethylene glycol poisoning. Rapid absorption from Stomach and Small Intestine; Toxicity results at doses >1.0 ml/kg. Toxicol Rev 2004; 23:189. Ethanol coingestion roughly doubles ethylene glycol half-life; Minimum lethal dose 1-1.5 mL/kg Volume depends on percentage of ethylene glycol in solution, typically 0.6 g/mL; 60 kg patient lethal dose ~ 100 mL ; Metabolites (eg. Authors Leo J Schep 1 , Robin J Slaughter, Wayne A Temple, D Michael G Beasley. Most people with ethylene glycol poisoning need to be admitted to a hospital’s intensive care unit (ICU) for close monitoring. Diethylene glycol (DEG) is a clear, colorless, odorless liquid with a sweet taste, and is an excellent solvent for water-insoluble chemicals and drugs. Ethylene glycol poisoning can cause dysrhythmias and heart failure. 4. A report of accidental ethylene glycol ingestion in 2 siblings. Clinically significant poisoning with ethylene glycol or methanol will invariably cause anion gap elevation. Am J Kidney Dis 1996; 27:130. French chemist Charles-Adolphe Wurtz first synthesized ethylene glycol in 1859 from potassium hydroxide using a saponification process similar to that used to produce commercial soaps. Large amounts of ethylene glycol wereremovedbydialysis. Ethylene glycol is most commonly found as the primary ingredient of automobile antifreeze and hydraulic brake fluids. 5. Poisoning; Poisoning Causes; Pathophysiology. It is an odorless, colorless, sweet-tasting, viscous liquid. This can help remove some of the poison. Children may be exposed by accidental ingestion caused by decantation of EG to unlabeled bottles. Baud FJ, Galliot M, Astier A, et al. Ethylene glycol poisoning is poisoning caused by drinking ethylene glycol. 2. It is a toxic, colorless, odorless, almost nonvolatile liquid with a sweet taste. Brent J, McMartin K, Phillips S, et al. Production Industrial routes. Those who recently (within 30 to 60 minutes of presentation to the emergency department) swallowed the ethylene glycol may have their stomach pumped (suctioned). A number of toxicological agents could be considered in addition to toxic alcohols, including tricyclic … Purssell RA, Lynd LD, Koga Y. Adults are typically exposed when EG is ingested as a cheap substitute for ethanol or in suicide-attempts. The use of the osmole gap as a screening test for the presence of exogenous substances. Ethylene glycol poisoning was immediately suspected, because the patient had previously been hospitalized with similar symptoms after intake of antifreeze coolant. Ethylene glycol (IUPAC name: ethane-1,2-diol) is an organic compound with the formula (CH 2 OH) 2. Ann Intern Med 105(1):16–20 CrossRef PubMed Google Scholar. Fri Dec 21, 2012. by Alicia Minns, MD. It is estimated that 6% of new-onset seizures are due to drug toxicity . Ethylene glycol is toxic and, if ingested, can cause fatal poisoning. [1] Later symptoms may include a decreased level of consciousness, headache, and seizures. Ethylene glycol tastes sweet and can make it appealing for children to drink. It is poisonous if swallowed. Investigations demonstratedleucocytosis,acidosis,uraemia,haema-turia and albuminuria. The anion gap will remain normal for several hours until a sufficient amount of EG has been metabolized to toxic acids. Moore MM et al (2008) Ethylene glycol toxicity: chemistry, pathogenesis, and imaging. Typically it is the accidental ingestion of ethylene glycol that causes this to occur. Clinical features ofethylene glycol poisoning Usual time … Ethylene glycol may be swallowed accidentally, or it may be taken deliberately in a suicide attempt or as a substitute for drinking alcohol (ethanol). Ethylene glycol came into widespread use in the 1920s and the first case of poisoning was described in 1930. Ethylene Glycol found in antifreeze and de-icer. Aka: Ethylene Glycol Poisoning, Ingestion of Ethylene Glycol, Ethylene Glycol, Ethylene Alcohol, Ethylene Dihydrate, Glycol Alcohol, Monoethylene Glycol, Antifreeze Fluid, De-icing solution. 70, n o 2, août 2006, p. Ethylene glycol is a colorless, odorless, sweet-tasting chemical. ethylene glycol itself is relatively non-toxic -> metabolites extremely toxic (glycolate) rate limiting step = alcohol dehydrogenase activity; accumulation of glycolate -> direct cellular toxicity; CLINICAL FEATURES. Ethylene glycol poisoning. Diethylene glycol poisoning Clin Toxicol (Phila). Nephrotoxicity is the dominant effect of significant ethylene glycol poisoning. Ethylene glycol poisoning 0 U c 8 100 g 75- 50 335 t m 0 704- - - - %03- OI aJ - E02- f W I I I I I I I I I I I 5 10 15 20 25 30 35 40 45 50 55 60 Time after admission (hours) Fig. Those who recently (within 30 to 60 minutes of presentation to the emergency department) swallowed the ethylene glycol may have their stomach pumped (suctioned). ↑ Field DL, « Acute ethylene glycol poisoning », dans Critical care medicine, vol. The toxicity of the glycols was, however, not fully appreciated until 1937 when 76 people died following the use of an elixir of surphanilamide which contained 72 per cent diethy-lene glycol. Ethylene Glycol is a common component of engine coolant, or antifreeze. Adults are typically exposed when EG is ingested as a cheap substitute for ethanol or in suicide-attempts. It is mainly used for two purposes, as a raw material in the manufacture of polyester fibers and for antifreeze formulations. Ethylene glycol poisoning Intoxication - ethylene glycol. Pathology 1995; 27:273. Ingestion of EG may cause serious poisoning. This can help remove some of the poison. WHAT CAUSES IT? Ethylene glycol poisoning is caused by the ingestion of ethylene glycol. Am J Med. The patient was treated with continuous intravenous … The presence of an anion gap may suggest significant ethylene glycol poisoning, but false-positive and false-negative results also occur. Fomepizole for the treatment of ethylene glycol poisoning. 61, n o 7,‎ 2001, p. 979–88 ( PMID 11434452 , DOI 10.2165/00003495-200161070-00006 ) 9. 1974 Jul;57(1):143-50. Antifreeze contains ethylene glycol, a very toxic chemical that causes severe damage to internal organs (even in very small amounts). In a late presentation of ethylene glycol poisoning, where ethylene glycol has already been metabolized by ADH to its metabolites, there may be little value; Ethanol is difficult to dose and has more adverse side effects; Fomepizole. See Also. J Emerg Med 15(5):653–667 CrossRef PubMed Google Scholar. Arterial blood gas analysis showed severe metabolic acidosis with pH of 6.89, bicarbonate level of 13 mEq/L and PaCO 2 of 33 mmHg. The blood levels of ethylene glycol (gllitre); X alcohol (mg/100 ml), and plasma oxalate (mmol/litre) are plotted against time (in hours) after admission to hospital. Ethylene glycol (EG) can be found in many agents, such as antifreeze. Ethylene glycol poisoning with a normal anion gap caused by concurrent ethanol ingestion: importance of the osmolal gap. N Engl J Med 1988; 319:97. 2009 Jul;47(6):525-35. doi: 10.1080/15563650903086444. Diethylene Glycol Poisoning. Most people with ethylene glycol poisoning need to be admitted to a hospital's intensive care unit (ICU) for close monitoring. Ethylene glycol poisoning and the lactate gap Ethylene glycol is often ingested either by accident or deliberately, and accumulation of toxic metabo-lites glycolic and oxalic acids can lead to severe acidosis with neurological, cardiovascular and renal complica-tions, and death [1]. Ethylene glycol (EG) can be found in many agents, such as antifreeze. sugar and negative for ketone body, hemoglobin of 17.1 g/dL, leucocyte count of 43,600/mm3 and platelet count of 380,000/mm3. Ethylene glycol poisoning refers to the unsafe ingestion of the toxic substance methanol. with peak serum levels occurring ~1 hour after ingestion). oxalate acid, glycolic acid) cause toxicity, but do NOT cause osmolal gap; Clinical Features Stage 1 - CNS. [1] Long term outcomes may include kidney failure and brain damage. Ethylene glycol exposure is characterized by an osmolal gap and a metabolic acidosis with an elevated anion gap. Acidosis/etiology TABLE 1. 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Pulmonary edema and ARDS anion gap will remain normal for several hours until sufficient.

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