Serum calcium on presentation was compared to blood gas pH on presentation as well as presentation serum bicarbonate. [ncbi.nlm.nih.gov]

• Weakness

  However, the patient who ingested methanol developed respiratory muscle stiffness/weakness, which responded poorly to anti-Parkinsonian drug therapy. Treatment with carbidopa/levodopa improved cogwheel rigidity and bradykinesia in both patients. [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]

  The signs of EG poisoning include excessive thirst and urination, lack of coordination, weakness, nausea, tremors, vomiting, rapid breathing and heart rate, convulsions, diarrhea, and paralysis. [resteddoginn.ca]

  Previous studies revealed that this cloud exhibits a weak concentration of emission of glycolaldehyde (CH 2 OHCHO) and ethylene glycol (HOCH 2 CH 2 OH). However, the exact extent of this emission remained unclear. [phys.org]

• 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]

• Unconsciousness

  We present the case of a young person, of the male persuasion, without any personal pathological history, found unconscious and presenting signs of violence. [ncbi.nlm.nih.gov]

  Never give anything by mouth to an unconscious person. In all cases call a physician. Product Use: Laboratory Reagent. Revision Information: Pure. New 16 section MSDS format, all sections have been revised. [hazard.com]

  — Paul Weissler, Popular Mechanics, "How to Pick the Right Motor Oil for Your Car," 14 Feb. 2019 Randy Eskelson was found unconscious Aug. 21 and taken to the hospital, where testing uncovered a potentially lethal dose of ethylene glycol in his system [merriam-webster.com]

  Never give anything by mouth to an unconscious person. In all cases call a physician. Product Use: Laboratory Reagent. Revision Information: MSDS Section(s) changed since last revision of document include: 8. [web.archive.org]

  If the victim is convulsing or unconscious, do not give anything by mouth, ensure that the victim's airway is open and lay the victim on his/her side with the head lower than the body. DO NOT INDUCE VOMITING. [cameochemicals.noaa.gov]

• Inflammation

  We describe a case of fatal EG poisoning in which the development of rapid cerebral edema was documented by CT scan and was accompanied by definitive evidence of birefringent crystals within walls of CNS blood vessels, with associated inflammation and [ncbi.nlm.nih.gov]

  If EG is splashed into the eye, it can cause swelling of the eyelid as well as inflammation and redness of the eye. Wash the eye with large amounts of cool water for 10-15 minutes, and then seek medical attention. [acmt.net]

  Muscle inflammation (myositis) may occur. EFFECTS OF CHRONIC OR REPEATED EXPOSURE: Ethylene glycol is not classifiable as a human carcinogen. Limited studies have not found ethylene glycol to be a carcinogen. [cdc.gov]

  The occurrence of inflammation of the Harderian gland in the exposed males, "pneumonial changes" in the lungs of males and females, and salivary adenitis was not considered related to exposure to ethylene glycol. [hc-sc.gc.ca]

• Chills

  Case report: severe ethylene glycol intoxication with normal osmolal gap—“a chilling thought.”. J Emerg Med 1990 ; 8 : 583 -585. ↵ Godolphin W, Meagher EP, Sanders HD, Frohlich J. Unusual calcium oxalate crystals in ethylene glycol poisoning. [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.medscape.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]

• Dyspnea

  If shortness of breath occurs or breathing is difficult (dyspnea), administer oxygen. Assist ventilation as required. Always use a barrier or bag-valve-mask device. If breathing has ceased (apnea), provide artificial respiration. [cdc.gov]

• 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]

  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]

  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]

  Do not try to induce vomiting. EG can cause nausea, vomiting, slurred speech, dizziness, unsteady gait, and abdominal pain. A person who is poisoned with EG may appear drunk. They may also have a sweet aromatic odor to their breath. [acmt.net]

• 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]

• 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]

  Mild to moderate, Stage 2: Increased heart rate (tachycardia); abnormal or disordered heart rhythms (dysrhythmia); increased blood pressure (hypertension); and build-up of toxic breakdown products in the blood stream (metabolic acidosis), resulting in [cdc.gov]

  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]

• Erythema

  Moderate to severe irritation of the eyes was reported for the continuously exposed rabbits (i.e., erythema, edema, discharge) and rats (i.e., corneal opacity and apparent blindness in 2 of 15 animals); however, these effects were not observed in a separate [hc-sc.gc.ca]

• Renal Insufficiency

  Despite early treatment with fomepizole and without the development of acidosis or renal insufficiency, the patient required HD for hyperosmolality and subsequent electrolyte imbalances. Indications for HD following EG intoxication are discussed. [ncbi.nlm.nih.gov]

  Eventually, oxalate is deposited in the kidney and elsewhere; renal insufficiency may ensue. [emedicine.medscape.com]

  Finally, delayed renal insufficiency follows deposition of oxalate in renal tubules. [mayomedicallaboratories.com]

• Kidney Failure

  failure and muscle or liver damage. [medlineplus.gov]

  \[\ce{Ca^{2+}(aq) + C_2O_4^{2−}(aq) \rightarrow CaC_2O_4(s)} \nonumber\] These crystals cause renal damage and can lead to kidney failure and death. [chem.libretexts.org]

  DELAYED EFFECTS OF EXPOSURE: Kidney (renal) failure can occur 24 to 72 hours after acute ethylene glycol ingestion. Some loss of kidney function may be permanent. [cdc.gov]

  damaging them; depending on the level of exposure, accumulation of the poison in the body can last weeks or months before causing death, but death by acute kidney failure can result within 72 hours if the individual does not receive appropriate medical [en.wikipedia.org]

• 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. [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]

  Severe, Stage 1: Decreased reflex responses, seizures, loss of consciousness, and coma. [cdc.gov]

  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]

• 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]

  […] in mental status, hypoglycemia, or respiratory depression. [emedicine.medscape.com]

  Ethylene glycol itself may cause some alteration of mental status but it is a relatively nontoxic compound before it is metabolized. The metabolites cause the distinctive toxicity associated with this compound. [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. [hazard.com]

• Headache

  […] 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]

  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. [hazard.com]

  Chronic or repeated exposure to ethylene glycol may lead to: irritation of the throat, mild headache, low backache, loss of consciousness, and nystagmus. These will resolve if the source of exposure is removed. [cdc.gov]

  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]

• Hyponatremia

  Osmotic demyelination syndrome (ODS) is traditionally known as a complication of the rapid correction of hyponatremia. [ncbi.nlm.nih.gov]

  Other potential adverse effects include hyponatremia, sclerosis of veins, and intoxication (which can be particularly distressing in pediatric patients). Any patient receiving intravenous ethanol therapy requires ICU monitoring. [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]

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]

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

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.medscape.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.medscape.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]