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Ethylene Glycol


Presentation

  • 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]
  • Serum calcium on presentation was compared to blood gas pH on presentation as well as presentation serum bicarbonate.[ncbi.nlm.nih.gov]
  • In this paper we present case of prolonged renal failure in the course of ethylene glycol intoxication.[ncbi.nlm.nih.gov]
  • 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]
  • His initial presenting serum ethylene glycol level was 700 mg/dL, with normal renal function, and a metabolic acidosis with a high anion gap. One hour after presentation, he was started on intravenous fomepizole.[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]
Sepsis
  • A broad differential diagnosis was considered at the time of the patient's presentation at the tertiary care center including ingestion of a volatile alcohol, sepsis, and an abdominal catastrophe.[ncbi.nlm.nih.gov]
  • Previous reports of malingering patients inducing illness include sepsis, kidney pain, migraine, and chest pain. However, acute poisoning as a manifestation of malingering appears to be rare.[ncbi.nlm.nih.gov]
Malingering
  • Malingering is when a patient feigns illness for secondary gain. While most patients with malingering manufacture or exaggerate symptoms, some patients may induce illness.[ncbi.nlm.nih.gov]
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]
  • 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]
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 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]
  • 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]
  • We report a case of a 75-year-old hypertensive, diabetic man who presented to the emergency room with symptoms and signs of nausea, acute intoxication, significant alteration in mental status with rapid neurologic deterioration, and blunt impact injuries[ncbi.nlm.nih.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]
Abdominal Tenderness
  • Physical examination revealed hyperventilation and abdominal tenderness. Blood gas analysis in the emergency department using an ABL 725 Radiometer analyser showed a severe metabolic acidosis with massive lactate elevation.[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]
  • 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]
Photosensitivity
  • In this study, we report the development of extremely small-sized globular poly(ethylene glycol) (gPEG) that can specifically recognize tumor acidic pH. gPEG coupled with chlorin e6 (Ce6, a photosensitizing drug) and 2,3-dimethylmaleic acid (DMA, as a[ncbi.nlm.nih.gov]
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]
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: 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]
Confusion
  • In this case, the child presented irritable, pale and confused with high anion gap metabolic acidosis.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • 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.medscape.com]
Ataxia
  • 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]
  • 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]

Workup

  • 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]
Base Deficit
  • Her admission data revealed a median pH of 7.31 (range 6.87-7.49), pCO(2): 4.2 kPa (1.2-6.7) (32 mmHg [9-50]), HCO-3: 15 mmol/L (4-26) (15 mEq/L [4-26]), base deficit (BD): 10 mmol/L (- 4 to 27) (10 mEq/L [-4 to 27]), serum-creatinine 65 μmol/L (40-133[ncbi.nlm.nih.gov]
Staphylococcus Aureus
  • aureus, Pseudomonas aeruginosa, and Escherichia coli).[ncbi.nlm.nih.gov]
  • This hydrogel demonstrated a sustained antibacterial activity against the bacterial strains Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli in comparison to the direct topical application of SSD.[ncbi.nlm.nih.gov]

Treatment

  • 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]
  • His concomitant ethanol consumption, early presentation, and treatment likely contributed to his favorable outcome. This case report underscores the effectiveness of supportive care and fomepizole in the treatment of ethylene glycol poisoning.[ncbi.nlm.nih.gov]
  • When given early, fomepizole has demonstrated an effective role in the treatment of ethylene glycol (EG) intoxication, often eliminating the need for hemodialysis (HD). Many indications for HD have been suggested for EG intoxication.[ncbi.nlm.nih.gov]
  • These results suggest that caffeic acid (1) can be further investigated for the prevention, and treatment of kidney stones.[ncbi.nlm.nih.gov]
  • Continuous venovenous hemodiafiltration can be helpful in treatment of ethylene glycol and methanol intoxication.[ncbi.nlm.nih.gov]

Prognosis

  • 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]
  • To evaluate the clinical utility of glycolic acid (GA) determination in the diagnosis and prognosis of ethylene glycol (EG) intoxications.[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]

Etiology

  • 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

  • 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]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • The pathophysiology underlying ethylene glycol intoxication, treatment strategies, and gastrointestinal toxicity are discussed.[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]

Prevention

  • 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]
  • Therefore, alkaline citrate was given as a preventive measure to increase urinary oxalate solubility, but nephrocalcinosis still developed. Metabolic acidosis, hypocalcaemia, and neurological symptoms had not occurred.[ncbi.nlm.nih.gov]
  • These brushes prevent non-specific adsorption of proteins and attachment of cells. Subsequently, the brushes can be modified with covalently tethered adhesive peptides that provide controlled cell adhesion.[ncbi.nlm.nih.gov]
  • We present five case reports of fatal EG-poisoning, and review the literature concerning clinical presentation and diagnosis, pathological findings, treatment and prevention.[ncbi.nlm.nih.gov]

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