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]. Children may be exposed by accidental ingestion caused by decantation of EG to unlabeled bottles. [1] Toxicity and death may occur after drinking even a small amount. 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 (IUPAC name: ethane-1,2-diol) is an organic compound with the formula (CH 2 OH) 2. ↑ Field DL, « Acute ethylene glycol poisoning », dans Critical care medicine, vol. A number of toxicological agents could be considered in addition to toxic alcohols, including tricyclic … 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. 2. This can help remove some of the poison. Clinically significant poisoning with ethylene glycol or methanol will invariably cause anion gap elevation. Ethylene glycol is most commonly found as the primary ingredient of automobile antifreeze and hydraulic brake fluids. 1974 Jul;57(1):143-50. 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. Ethylene glycol may be swallowed accidentally, or it may be taken deliberately in a suicide attempt or as a substitute for drinking alcohol (ethanol). See Also. Ethylene glycol poisoning through ingestion can cause noncardiogenic pulmonary edema and ARDS. 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. The relevant pharmacokinetics are as follows: Ethylene glycol and methanol are both readily absorbed from the gut (e.g. Those who recently (within 30 to 60 minutes of presentation to the emergency department) swallowed the ethylene glycol may have their stomach pumped (suctioned). 1. Typically it is the accidental ingestion of ethylene glycol that causes this to occur. Clinical features ofethylene glycol poisoning Usual time … 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 poisoning can cause dysrhythmias and heart failure. 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 tastes sweet and can make it appealing for children to drink. 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 is caused by the ingestion of ethylene glycol. Ethylene Glycol is a common component of engine coolant, or antifreeze. TABLE 1. Introduction. Davis DP et al (1997) Ethylene glycol poisoning: case report of a record-high level and a review. 2009 Jul;47(6):525-35. doi: 10.1080/15563650903086444. Most people with ethylene glycol poisoning need to be admitted to a hospital’s intensive care unit (ICU) for close monitoring. Ethylene glycol poisoning can present a diagnostic challenge in the emergency unit. Diethylene Glycol Poisoning. A urine sample was sent for microscopy and showed multiple calcium oxalate monohydrate (COM) crystals, which supported the clinical suspicion of ethylene glycol poisoning. Ethylene glycol poisoning. Treatment of ethylene glycol poisoning with intravenous 4-methylpyrazole. Am J Med. Ethylene Glycol found in antifreeze and de-icer. Toxicol Rev 2004; 23:189. Ethylene glycol is a colorless, odorless, sweet-tasting chemical. Fomepizole for the treatment of ethylene glycol poisoning. 4. Most people with ethylene glycol poisoning need to be admitted to a hospital's intensive care unit (ICU) for close monitoring. Ethylene glycol poisoning was immediately suspected, because the patient had previously been hospitalized with similar symptoms after intake of antifreeze coolant. The use of the osmole gap as a screening test for the presence of exogenous substances. Sadly, antifreeze poisoning is often fatal unless it's treated extremely quickly. It is estimated that 6% of new-onset seizures are due to drug toxicity . Gabow PA et al (1986) Organic acids in ethylene glycol intoxication. EMERGENCY: Antifreeze (ethylene glycol) is highly toxic – contact your vet immediately if you think your pet has been exposed to it. Ethylene glycol is toxic and, if ingested, can cause fatal poisoning. 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. 61, n o 7,‎ 2001, p. 979–88 ( PMID 11434452 , DOI 10.2165/00003495-200161070-00006 ) 9. J Emerg Med 15(5):653–667 CrossRef PubMed Google Scholar. 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 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 with a normal anion gap caused by concurrent ethanol ingestion: importance of the osmolal gap. Diethylene glycol poisoning Clin Toxicol (Phila). Ethylene Glycol Poisoning and Hyperglycemia A. R. Kunnummal Madathodi et al. The issue is when we can expect to see this elevation in anion gap. Ethylene glycol poisoning is poisoning caused by drinking ethylene glycol. Fri Dec 21, 2012. by Alicia Minns, MD. Am J Kidney Dis 1996; 27:130. Pathology 1995; 27:273. Purssell RA, Pudek M, Brubacher J, Abu-Laban RB. Rapid absorption from Stomach and Small Intestine; Toxicity results at doses >1.0 ml/kg. Production Industrial routes. Brent J, McMartin K, Phillips S, et al. Ethylene glycol poisoning is caused by the ingestion of ethylene glycol, the primary ingredient in automotive antifreeze. 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. Adults are typically exposed when EG is ingested as a cheap substitute for ethanol or in suicide-attempts. Most ethylene glycol poisonings occur due to the ingestion of antifreeze. with peak serum levels occurring ~1 hour after ingestion). It can be found in: Antifreeze Authors Leo J Schep 1 , Robin J Slaughter, Wayne A Temple, D Michael G Beasley. [1] Later symptoms may include a decreased level of consciousness, headache, and seizures. Poisoning; Poisoning Causes; Pathophysiology. A breathing machine (respirator) may be needed. A report of accidental ethylene glycol ingestion in 2 siblings. Purssell RA, Lynd LD, Koga Y. It is an odorless, colorless, sweet-tasting, viscous liquid. ethylene glycol poisoning (Tables 1 &2) including vomiting, haematemesis, coma, convulsions, oph-thalmoplegia, tachycardia, tachypnoea, pulmonary oedema and acute renal damage. Ann Intern Med 105(1):16–20 CrossRef PubMed Google Scholar. A breathing machine (respirator) may be needed. This can help remove some of the poison. 70, n o 2, août 2006, p. Moore MM et al (2008) Ethylene glycol toxicity: chemistry, pathogenesis, and imaging. (en) Brent J, « Current management of ethylene glycol poisoning », Drugs, vol. Human studies have shown no link … It is a toxic, colorless, odorless, almost nonvolatile liquid with a sweet taste. It is mainly used for two purposes, as a raw material in the manufacture of polyester fibers and for antifreeze formulations. The anion gap will remain normal for several hours until a sufficient amount of EG has been metabolized to toxic acids. Ethylene glycol (EG) can be found in many agents, such as antifreeze. The major factor prompting us to consider a toxicological cause for seizures in this patient, was the severe HAGMA. Antifreeze contains ethylene glycol, a very toxic chemical that causes severe damage to internal organs (even in very small amounts). Those who recently (within 30 to 60 minutes of presentation to the emergency department) swallowed the ethylene glycol may have their stomach pumped (suctioned). 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. 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. Ethylene glycol poisoning Intoxication - ethylene glycol. Large amounts of ethylene glycol wereremovedbydialysis. Ingestion of EG may cause serious poisoning. 5. Ethylene glycol exposure is characterized by an osmolal gap and a metabolic acidosis with an elevated anion gap. Investigations demonstratedleucocytosis,acidosis,uraemia,haema-turia and albuminuria. WHAT CAUSES IT? 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. Parry MF, Wallach R. PMID: 4834513 [PubMed - indexed for MEDLINE] MeSH Terms. The presence of an anion gap may suggest significant ethylene glycol poisoning, but false-positive and false-negative results also occur. [1] Long term outcomes may include kidney failure and brain damage. [1] Early symptoms include intoxication, vomiting and abdominal pain. drunk: automotive antifreeze, solvent, polish, paints, cosmetics, brake fluid, car wash fluid. It is poisonous if swallowed. Aka: Ethylene Glycol Poisoning, Ingestion of Ethylene Glycol, Ethylene Glycol, Ethylene Alcohol, Ethylene Dihydrate, Glycol Alcohol, Monoethylene Glycol, Antifreeze Fluid, De-icing solution. N Engl J Med 1988; 319:97. Ingestion of EG may cause serious poisoning. Nephrotoxicity is the dominant effect of significant ethylene glycol poisoning. oxalate acid, glycolic acid) cause toxicity, but do NOT cause osmolal gap; Clinical Features Stage 1 - CNS. The patient was treated with continuous intravenous … Adults are typically exposed when EG is ingested as a cheap substitute for ethanol or in suicide-attempts. Children may be exposed by accidental ingestion caused by decantation of EG to unlabeled bottles. Ethylene glycol came into widespread use in the 1920s and the first case of poisoning was described in 1930. Ethylene glycol poisoning refers to the unsafe ingestion of the toxic substance methanol. Baud FJ, Galliot M, Astier A, et al. 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. Acidosis/etiology Is an odorless, almost nonvolatile liquid with a sweet taste to see this elevation in anion gap will normal. Août 2006, p. a report of accidental ethylene glycol poisoning need to be admitted a! M, Astier a, et al ( 1997 ) ethylene glycol poisoning is by..., ‎ 2001, p. a report of a record-high level and a metabolic acidosis with an elevated gap. 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