We present a patient with delayed presentation of ethylene glycol ingestion and review the physiology and biochemistry that underlies this different presentation. [ncbi.nlm.nih.gov]

• Gastric Lavage

  Lavage is not effective Activated Charcoal is not effective [fpnotebook.com]

  Further absorption of EG is prevented by induction of emesis or gastric lavage (or both) within 1–2 hr of ingestion, although the rapidity of EG absorption from the GI tract suggests these procedures may not be beneficial. [merckmanuals.com]

  There is no role for activated charcoal, cathartics or gastric lavage in ethylene glycol intoxication. Alcoholics and patients likely to be malnourished should be given thiamine and pyridoxine. [renalandurologynews.com]

  Treatment included gastric lavage, charcoal, and intravenous ethanol. The serum ethanol concentration was maintained between 17 and 22 mmol/L (76–103 mg/dL). [clinchem.aaccjnls.org]

• Tachypnea

  Signs include lethargy, anorexia, dehydration, vomiting, diarrhea, oral ulcers, salivation, tachypnea, and possibly seizures or coma. The kidneys are often swollen and painful on abdominal palpation. [merckmanuals.com]

  Initially, patients may be asymptomatic, but ethylene glycol is rapidly absorbed (within 1 to 4 hours), and altered mental status and tachypnea then begin to appear as the ethylene glycol is successively metabolized to very toxic compounds. [emedicine.com]

  As the high osmolar gap resolves, HAGMA (high anion gap metabolic acidosis) and hypocalcemia occur, with clinical manifestations that include dyspnoea, tachypnea, tachycardia, hypertension, shock, coma, tetany, seizures and death. [lifeinthefastlane.com]

• Vomiting

  The authors report a patient who had recurrent episodes characterized by nausea, vomiting, and signs of dehydration necessitating admission to the hospital. At each admission, he was found to have lactic acidosis. [ncbi.nlm.nih.gov]

  Exposure Routes inhalation, ingestion, skin and/or eye contact Symptoms irritation eyes, skin, nose, throat; nausea, vomiting, abdominal pain, lassitude (weakness, exhaustion); dizziness, stupor, convulsions, central nervous system depression; skin sensitization [cdc.gov]

  If swallowed, give water or milk to drink and induce vomiting. Never give anything by mouth to an unconscious person. In all cases call a physician. Product Use: Laboratory Reagent. [web.archive.org]

  Ingestion: Induce vomiting immediately as directed by medical personnel. Never give anything by mouth to an unconscious person. Get medical attention. Skin Contact: Remove any contaminated clothing. [hazard.com]

  Dogs and cats exhibit vomiting due to GI irritation, polydipsia and polyuria, and neurologic signs (CNS depression, stupor, ataxia, knuckling, decreased withdrawal and righting reflexes). [merckmanuals.com]

• Nausea

  The previously reported gastrointestinal side effects of ethylene glycol toxicity are mostly nonspecific, including nausea, abdominal pain, and cramping. In addition, hepatic damage due to calcium oxalate deposition has been reported. [ncbi.nlm.nih.gov]

  Exposure Routes inhalation, ingestion, skin and/or eye contact Symptoms irritation eyes, skin, nose, throat; nausea, vomiting, abdominal pain, lassitude (weakness, exhaustion); dizziness, stupor, convulsions, central nervous system depression; skin sensitization [cdc.gov]

  […] threshold Behavioral - coma Gastrointestinal - hypermotility, diarrhea TYPE OF TEST : LDLo - Lowest published lethal dose ROUTE OF EXPOSURE : Oral SPECIES OBSERVED : Human DOSE/DURATION : 398 mg/kg TOXIC EFFECTS : Behavioral - headache Gastrointestinal - nausea [chemsrc.com]

• Cheilitis

  Herein we report a patient with accidental ethylene glycol contact to the lower lip, who presented with acute, manifest, actinic cheilitis-like chemical irritant reaction and favorably responded to topical pimecrolimus 1% cream. [ncbi.nlm.nih.gov]

• Tachycardia

  His examination was significant for confusion, acetone odour, tachycardia and tachypnoea. Further blood tests revealed an anion gap of 31 mEq/L, serum osmolal gap of 34 mOsm/kg, and creatinine 3.6 mg/dL. [ncbi.nlm.nih.gov]

  As the high osmolar gap resolves, HAGMA (high anion gap metabolic acidosis) and hypocalcemia occur, with clinical manifestations that include dyspnoea, tachypnea, tachycardia, hypertension, shock, coma, tetany, seizures and death. [lifeinthefastlane.com]

  Hypertension, tachycardia, and cardiac failure may ensue. Pneumonitis, pulmonary edema, and adult respiratory distress syndrome have also been reported. 3, 9 Renal involvement may become apparent within 24 to 72 hours after ingestion. [aafp.org]

  Cardiopulmonary manifestations may be observed 12–24 h after ingestion and may include tachypnea, tachycardia, hypertension, pulmonary edema, and congestive heart failure. [clinchem.aaccjnls.org]

  Signs of acute ingestion of ethylene glycol are dose dependent and include central nervous system depression, paralysis, ataxia, respiratory arrest, tachycardia, tachypnea, coma and death (BUA, 1994). [hc-sc.gc.ca]

• Oliguria

  Recovery after prolonged oliguria due to ethylene glycol intoxication. Arch Intern Med 1970 ; 125 : 1059 -1062. Gutman RA, Hamon CB, Striker GE. Recovery after prolonged oliguria. Arch Intern Med 1970 ; 126 : 914 -915. [clinchem.aaccjnls.org]

• Seizure

  Observed symptoms of intoxication were seizures, respiratory depression, arrhythmias and hypotonia. All died in hospital after failed attempts at resuscitation, one person did so after an 11h dialysis treatment. [ncbi.nlm.nih.gov]

  Seizures — control with IV benzodiazepines, and intubate and ventilate as required (see above). [lifeinthefastlane.com]

  Diagnose Multiple Systems Atrophy based on the 2008 criteria Arteriovenous Malformation Coma/Level of Consciousness Demyelinating Disease Dermatome Map Functional Outcome Head & Neck Trauma Headache Intracerebral Hemorrhage Ischemic Stroke Neurophysiology Seizure [qxmd.com]

  About 3-12 hours after ingestion, a person can develop seizures, tremors, rapid shallow breathing, and worsening sleepiness that may progress to coma and death. Kidney failure is a well-known complication of EG poisoning. [acmt.net]

  Lowest published lethal dose ROUTE OF EXPOSURE : Intravenous SPECIES OBSERVED : Rodent - rabbit DOSE/DURATION : 5 gm/kg TOXIC EFFECTS : Behavioral - somnolence (general depressed activity) Behavioral - tremor Behavioral - convulsions or effect on seizure [chemsrc.com]

• Confusion

  A 29-year-old male presented at the emergency department of our hospital in a confused state. He had a history of psychoses and substance abuse. Physical examination revealed hyperventilation and abdominal tenderness. [ncbi.nlm.nih.gov]

  Gimbanjang/iStock/GettyImages Sometimes two compounds have similar-sounding names but would be disastrous if confused. Polyethylene glycol and ethylene glycol are two of these substances. [sciencing.com]

  […] acidemia may be confused with ethylene glycol in the gas chromatographic assay. [mayomedicallaboratories.com]

• Altered Mental Status

  This case demonstrates the importance of early recognition of potential ingestions in patients with altered mental status and supportive laboratory findings. [ncbi.nlm.nih.gov]

  mental status after a fall at home. [nejm.org]

  Foley catheterization may be considered for patients with altered mental status, to monitor urinary output and to allow serial examination of urine for crystals or fluorescence. [emedicine.medscape.com]

  Initially, patients may be asymptomatic, but ethylene glycol is rapidly absorbed (within 1 to 4 hours), and altered mental status and tachypnea then begin to appear as the ethylene glycol is successively metabolized to very toxic compounds. [emedicine.com]

• Stupor

  Exposure Routes inhalation, ingestion, skin and/or eye contact Symptoms irritation eyes, skin, nose, throat; nausea, vomiting, abdominal pain, lassitude (weakness, exhaustion); dizziness, stupor, convulsions, central nervous system depression; skin sensitization [cdc.gov]

  Symptoms may include nausea, vomiting, convulsions, stupor (decreased level of alertness), or even coma. [medlineplus.gov]

  Dogs and cats exhibit vomiting due to GI irritation, polydipsia and polyuria, and neurologic signs (CNS depression, stupor, ataxia, knuckling, decreased withdrawal and righting reflexes). [merckmanuals.com]

  Ingestion causes stupor or coma, sometimes leading to fatal kidney injury. [cameochemicals.noaa.gov]

  Ingestion: Initial symptoms in massive dosage parallel alcohol intoxication, progressing to CNS depression, vomiting, headache, rapid respiratory and heart rate, lowered blood pressure, stupor, collapse, and unconsciousness with convulsions. [web.archive.org]

• Headache

  Exposure to vapors over an extended time period has caused throat irritation and headache. May cause nausea, vomiting, dizziness and drowsiness. Pulmonary edema and central nervous system depression may also develop. [web.archive.org]

  […] the 2017 criteria Diagnosis of Multiple System Atrophy (MSA) Diagnose Multiple Systems Atrophy based on the 2008 criteria Arteriovenous Malformation Coma/Level of Consciousness Demyelinating Disease Dermatome Map Functional Outcome Head & Neck Trauma Headache [qxmd.com]

  […] convulsions or effect on seizure threshold Behavioral - coma Gastrointestinal - hypermotility, diarrhea TYPE OF TEST : LDLo - Lowest published lethal dose ROUTE OF EXPOSURE : Oral SPECIES OBSERVED : Human DOSE/DURATION : 398 mg/kg TOXIC EFFECTS : Behavioral - headache [chemsrc.com]

  Human systemic effects by ingestion and inhalation: eye lachrymation, general anesthesia, headache, cough, respiratory stimulation, nausea or vomiting, pulmonary, kidney, and liver changes. [chemicalbook.com]

Workup for his neutrophilia excluded infectious and malignant causes. An elevated leukocyte alkaline phosphatase (LAP) level confirmed a leukemoid response, and the neutrophila resolved. [ncbi.nlm.nih.gov]

Second, the patient has a definite history of recent ethylene glycol ingestion (especially if the osmolal gap is 10 mOsm/L or more, though patients with potentially toxic ethylene glycol ingestions may have an apparently normal osmolar gap; see Workup [emedicine.medscape.com]

Treatment with fomepizole continued until the patient's plasma ethylene glycol concentration was 16 mg/dL. His metabolic acidosis quickly resolved, he had no adverse reactions to the treatment, and his renal function remained normal. [ncbi.nlm.nih.gov]

Ethylene glycol intoxication is one of the most serious acute poisonings with very uncertain prognosis with regard to both recovery and survival. [ncbi.nlm.nih.gov]

The prognosis varies inversely with the amount of time that elapses between ingestion and initiation of treatment. [merckmanuals.com]

Treatment and prognosis With prompt and appropriate therapy, ethylene glycol toxicity can be minimized. Treatment is primarily with haemodialysis, administration of bicarbonate (to counteract metabolic acidosis), and fomepizole 1. [radiopaedia.org]

Although the test is not a good indicator of prognosis, a documented level above 20 mg per dL (3 mmol per L) is an indication for treatment with fomepizole (Antizol). 4 The excretion of calcium oxalate crystals in the urine is a finding in approximately [aafp.org]

Indeed, calcium oxalate crystals are considered to be important etiological agents in the development of the renal failure in humans acutely poisoned by the ingestion of ethylene glycol (Jacobsen and McMartin, 1986; Wiley, 1999). [hc-sc.gc.ca]

Epidemiology Frequency United States Ethylene glycol is a relatively common cause of overdose in US emergency departments. [emedicine.com]

Identified epidemiological studies are restricted to two investigations, the results of which are considered inadequate to assess the carcinogenicity of ethylene glycol in humans. [hc-sc.gc.ca]

We briefly review the pathophysiology and current treatment strategies for ethylene glycol intoxication, and discuss issues surrounding enteral versus parenteral ethanol administration. [ncbi.nlm.nih.gov]

Useful For Suggests clinical disorders or settings where the test may be helpful Confirming and monitoring ethylene glycol toxicity Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory [mayomedicallaboratories.com]

Pathophysiology [2] Like the other toxic alcohols mentioned above, ethylene glycol is a parent compound that exerts most of its toxicity by conversion to metabolites. [emedicine.com]

These results suggest that caffeic acid (1) can be further investigated for the prevention, and treatment of kidney stones. [ncbi.nlm.nih.gov]

[…] lassitude (weakness, exhaustion); dizziness, stupor, convulsions, central nervous system depression; skin sensitization Target Organs Eyes, skin, respiratory system, central nervous system Personal Protection/Sanitation ( See protection codes ) Skin: Prevent [cdc.gov]

Treatment involves intravenous alcohol to prevent EG from being converted to oxalic acid that damages the kidneys. [resteddoginn.ca]