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Ethylene Glycol Poisoning

Ethylene Glycol Toxicity


Presentation

  • Early empiric ethanol therapy and consideration of dialysis are recommended for those patients with such a presentation without evidence of abnormal levels of ketones, lactate, salicylate, or ethanol.[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]
  • A 36-year-old man known as chronic alcohol abuser presently suffered from arthralgia and showed bilateral petriefied kidneys by sonography and computed tomography.[ncbi.nlm.nih.gov]
  • We report two cases of EG poisoning, both presenting without an elevated serum osmol gap and we discuss conditions which facilitate such a presentation, especially delayed hospital admission.[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]
Disability
  • Early, aggressive treatment with appropriate therapies, such as ethanol therapy, hemodialysis, vitamin cofactors, and antidotal agents, is necessary to prevent permanent disability or death.[ncbi.nlm.nih.gov]
  • Ingestion of as little as 30 to 60 mL can result in death or serious permanent disability. Traditional management of poisoning includes the use of ethanol, with or without hemodialysis.[ncbi.nlm.nih.gov]
Fatigue
  • **Subjects complaining of fatigue or ataxia were considered symptomatic.[doi.org]
Rales
  • Results of physical examination were remarkable for bilateral pulmonary rales and mild hepatomegaly. On the first hospital day, he became increasingly anxious, restless, and tachypneic with subxiphoid pain radiating to his back.[web.archive.org]
Hemoptysis
  • Briefly, he was a 23-year-old man with a 1-year history of dilated cardiomyopathy and pulmonary hypertension who experienced shortness of breath, productive cough, hemoptysis, nausea, and vomiting over the 2 days before admission.[web.archive.org]
Productive Cough
  • Briefly, he was a 23-year-old man with a 1-year history of dilated cardiomyopathy and pulmonary hypertension who experienced shortness of breath, productive cough, hemoptysis, nausea, and vomiting over the 2 days before admission.[web.archive.org]
Vomiting
  • Signs of walking drunk, drooling/hypersalivating, vomiting, seizuring, vomiting, and excessive thirst and urination are seen.[petpoisonhelpline.com]
  • During the first hours of ethylene glycol poisoning, the patient suffers from drunkenness, vomiting and somnolence due to the intoxicant effect of ethylene glycol on the central nervous system.[ncbi.nlm.nih.gov]
  • EARLY: - CS of CNS depression - Vomiting - ataxia, polyuria, polydipsia - metabolic acidosis characterized by a high anion gap - isosthenuria - calcium oxalate monohydrate or dihydrate crystalluria - hyperosmolality ( if available) - in dogs EG test kit[quizlet.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).[merckvetmanual.com]
Nausea
  • After the glycoaldehyde forms (at 4-12 hours) and metabolic acidosis begins, CNS depression—if it is a serious intoxication—can lead to the following effects: seizures coma cerebral edema (in some cases) gastrointestinal irritation (nausea and vomiting[atsdr.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.[web.archive.org]
  • Abstract 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[doi.org]
  • Symptoms may include nausea, vomiting, convulsions, stupor (decreased level of alertness), or even coma.[ufhealth.org]
Abdominal Pain
  • Case presentation A 53-year-old Afro-Caribbean man was admitted to another institution with a two-day history of vomiting, hiccups and abdominal pain.[jmedicalcasereports.biomedcentral.com]
  • The first phase typically involves gastrointestinal effects such as nausea, vomiting, abdominal pain and diarrhea. Patients may be inebriated and mild hypotension has been reported.[calpoison.org]
  • Signs and Symptoms of Antifreeze Poisoning Nausea Vomiting Abdominal pain Frequent and/or painful urination Kidney pain and eventually kidney failure Dizziness Stupor similar to intoxication (drunkeness) Shortness of breath ( dyspnea ) Rapid breathing[healthhype.com]
  • 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]
Jaundice
  • On physical examination, he was jaundiced, in mild respiratory distress, febrile [37.8 C (100 F)], tachycardic (126/min), and tachypneic (26/min). Results of physical examination were remarkable for bilateral pulmonary rales and mild hepatomegaly.[web.archive.org]
Hepatomegaly
  • Results of physical examination were remarkable for bilateral pulmonary rales and mild hepatomegaly. On the first hospital day, he became increasingly anxious, restless, and tachypneic with subxiphoid pain radiating to his back.[web.archive.org]
Costovertebral Angle Tenderness
  • The following conditions characterize the third phase flank pain, costovertebral angle tenderness, and oliguric renal failure.[atsdr.cdc.gov]
  • Renal complications are generally a late feature, occurring 24–72 h after ingestion, and consist of flank pain, costovertebral angle tenderness, oliguria, and renal failure.[web.archive.org]
Denial
  • Denial of ethylene glycol ingestion occurs because the patient or a third party either is concealing intentional poisoning or is unaware of consumption.[web.archive.org]
  • Parents might under- or overestimate the ingested dose because of denial or anxiety. Poison center staffs often record the dose taken as the worst case scenario in order to provide a wide margin of safety.[doi.org]
Seizure
  • RESULTS: The D/RI group was more likely than the RECOV group to present comatose, have seizures, and require intubation.[ncbi.nlm.nih.gov]
  • A 60-year-old African-American man with a medical history significant for heavy alcohol abuse, hypertension, delirium tremens, nephrolithiasis and seizure disorder was brought to the hospital with altered mental status.[ncbi.nlm.nih.gov]
  • Signs of walking drunk, drooling/hypersalivating, vomiting, seizuring, vomiting, and excessive thirst and urination are seen.[petpoisonhelpline.com]
  • Parenteral calcium may be necessary for treatment of tetany or seizures caused by hypocalcaemia. Sodium bicarbonate is given to correct the metabolic acidosis.[caribbean.scielo.org]
Stupor
  • Clinical manifestations of the ethylene glycol intoxication can be divided in three phases: a neurologic stage, with hallucinations, stupor and coma; the second stage is cardiovascular with cardiac failure.[ncbi.nlm.nih.gov]
  • Symptoms may include nausea, vomiting, convulsions, stupor (decreased level of alertness), or even coma.[ufhealth.org]
Headache
  • He had experienced headache the previous day but had been otherwise well. Investigations revealed a severe metabolic acidosis, raised lactate and acute kidney injury.[ncbi.nlm.nih.gov]
  • Ethylene glycol kills by first affecting the central nervous system, causing symptoms such as headache, confusion, slurred speech and tremors, according to ATSDR.[foxnews.com]
  • […] elevated serum creatinine at last study reading Ethylene glycol metabolites All patients demonstrated progressive reduction in blood glycolate concentration Cranial neuropathies 0/19 patients Side effects 2 patients had seizures, 2 patients experienced headaches[bestbets.org]
  • Two patients had headaches: one 16 hours after his last dose of fomepizole and one during the second day of a two-day course of therapy.[dx.doi.org]
Nystagmus
  • This state of alcohol intoxication occurs within 1-2 hours and is characterized by euphoria, nystagmus, drowsiness, nausea and vomiting. The patient has a high osmolar gap.[lifeinthefastlane.com]
  • Stage 1 (0,5 to 12 hours) consist of neurological and gastrointestinal symptoms; people may appear to be intoxicated, exhibiting symptoms such as dizziness, incoordination of muscles movements, nystagmus, headaches, slurred speech and confusion.[flipper.diff.org]
  • Neurological manifestations are apparent within 0.5–12 h of ingestion and include inebriation in the absence of detectable ethanol on breath or in blood, nausea, vomiting, nystagmus, papilledema, depressed reflexes, convulsions, and coma.[web.archive.org]
Papilledema
  • Neurological manifestations are apparent within 0.5–12 h of ingestion and include inebriation in the absence of detectable ethanol on breath or in blood, nausea, vomiting, nystagmus, papilledema, depressed reflexes, convulsions, and coma.[web.archive.org]
Kidney Failure
  • Delayed treatment often is not effective, and once a dog or cat has developed kidney failure, the prognosis is poor.[petpoisonhelpline.com]
  • Once kidney failure has developed in dogs and cats, the outcome is poor.[en.wikipedia.org]
  • Dialysis is also needed by people who develop severe kidney failure as a result of poisoning. It may be needed for many months and possibly years, afterward.[ufhealth.org]
Renal Insufficiency
  • This patient never demonstrated evidence of calcium oxalate crystalluria or renal insufficiency.[ncbi.nlm.nih.gov]
  • When ingested in the form of antifreeze or other automotive products, ethylene glycol results in central nervous system depression, cardiopulmonary compromise, and renal insufficiency.[ncbi.nlm.nih.gov]
  • BACKGROUND: We assessed the predictive value of selected factors on the outcomes of death and prolonged renal insufficiency (RI) from ethylene glycol poisoning.[ncbi.nlm.nih.gov]
  • Eventually, oxalate is deposited in the kidney and elsewhere; renal insufficiency may ensue.[emedicine.medscape.com]
Oliguria
  • A young man presented to the emergency department with mental status changes, severe metabolic acidosis, and oliguria. Acute ethylene glycol intoxication was diagnosed.[ncbi.nlm.nih.gov]
  • History / PE : Flank pain, hematuria, oliguria (ARF) Diagnosis : Anion gap acidosis Elevated creatinine Calcium oxalate crystal deposition in kidneys Treatment : 1) Fomepizole or ethanol ( ADH inhibition) 2) Sodium bicarbonate (correct acidosis) 3) Hemolysis[medlibes.com]
  • […] polydipsia - metabolic acidosis characterized by a high anion gap - isosthenuria - calcium oxalate monohydrate or dihydrate crystalluria - hyperosmolality ( if available) - in dogs EG test kit LATE: - depression - anorexia, vomiting - azotemia, and oliguria[quizlet.com]
  • Collins JM, Hennes DM, Holzgang CR, Gourley RT, Porter GA. (1970) Recovery after prolonged oliguria due to ethylene glycol intoxication. Arch Intern Med 125, 1059-62. Go to original source... Go to PubMed...[doi.org]
Anuria
  • - metabolic acidosis characterized by a high anion gap - isosthenuria - calcium oxalate monohydrate or dihydrate crystalluria - hyperosmolality ( if available) - in dogs EG test kit LATE: - depression - anorexia, vomiting - azotemia, and oliguria or anuria[quizlet.com]
  • If left untreated, patients may die within a week after the onset of anuria. Additionally, mild to moderate hepatotoxicity is often seen.[calpoison.org]
  • Our patient's presenting symptoms of abdominal pain, constipation and anuria, along with the investigations revealing raised inflammatory markers, acute renal failure and an abdominal CT which suggested bilateral pyelonephritis, pointed towards a diagnosis[jmedicalcasereports.biomedcentral.com]
  • Most renal damage is reversible and renal recovery, which may take a few months, is the norm even after anuria.[renalandurologynews.com]
Microscopic Hematuria
  • Twelve patients had oxalate crystaluria and eight had microscopical hematuria. Characteristics at Presentation Figure 2. Figure 2.[dx.doi.org]
  • Other frequently reported findings on urinalysis in cases of ethylene glycol poisoning include low specific gravity, proteinuria, and microscopic hematuria. laboratory measurement of ethylene glycol metabolites Examination of urine for calcium oxalate[web.archive.org]

Workup

  • 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

  • We studied the efficacy of fomepizole, a new inhibitor of alcohol dehydrogenase, in the treatment of ethylene glycol poisoning.[ncbi.nlm.nih.gov]
  • Expeditious diagnosis and treatment will limit metabolic toxicity and decrease morbidity and mortality.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To assess the use of fomepizole in the treatment of ethylene glycol poisoning in the absence of hemodialysis.[ncbi.nlm.nih.gov]
  • The overall comparative cost of medical treatment using each antidote requires further study.[dx.doi.org]

Prognosis

  • Although severe acidosis in the presence of serious illness is usually associated with a poor prognosis, our case emphasized the importance of aggressive supportive care and antidotal therapy for ethylene glycol poisoning even when there is a low pH.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To evaluate the clinical utility of glycolic acid (GA) determination in the diagnosis and prognosis of ethylene glycol (EG) intoxications.[ncbi.nlm.nih.gov]
  • This review encompasses an assessment of analytical methods for the analytes relevant for the diagnosis and prognosis of ethylene glycol poisoning and of the role of the ethylene glycol metabolites, glycolic and oxalic acids, in its toxicity.[ncbi.nlm.nih.gov]
  • Prognosis is excellent in both poisonings provided that there is early treatment with alkali to combat acidosis, ethanol as an antimetabolite, and haemodialysis to remove the alcohols and their toxic metabolites.[ncbi.nlm.nih.gov]
  • Delayed treatment often is not effective, and once a dog or cat has developed kidney failure, the prognosis is poor.[petpoisonhelpline.com]

Etiology

  • The etiology of the central nervous system, metabolic, cardiopulmonary, and renal toxicities are primarily due to the formation and accumulation of toxic intermediary metabolites, especially aldehyde metabolites 9 Parry M F, Wallach R.[dx.doi.org]

Epidemiology

  • Primary Entity # Journal of exposure analysis and environmental epidemiology official publication of the International Society of Exposure Analysis (ISEA). a schema:CreativeWork, schema:MediaObject, schema:Periodical ; library:oclcnum " 705256734 " ;[worldcat.org]
  • Epidemiology Frequency United States Ethylene glycol is a relatively common cause of overdose in US emergency departments.[emedicine.com]
  • Epidemiology The majority of documented cases of DEG poisoning have been epidemics where DEG was substituted in pharmaceutical preparations for the more expensive, but nontoxic glycols or glycerins.[calpoison.org]
  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
Sex distribution
Age distribution

Pathophysiology

  • A comprehensive review of the literature on the pathology and pathophysiology of ethylene glycol toxicity on each organ system is provided, along with information on diagnosis and current treatment recommendations.[ncbi.nlm.nih.gov]
  • The pathophysiologic basis of medical toxicology: the organ system approach -- Part. D.[worldcat.org]
  • 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]
  • Pathophysiology There is limited data regarding DEG and most information is derived from published experimental studies. DEG is readily absorbed orally. Dermal absorption has been reported through damaged skin involving a large surface area.[calpoison.org]

Prevention

  • 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]
  • Early, aggressive treatment with appropriate therapies, such as ethanol therapy, hemodialysis, vitamin cofactors, and antidotal agents, is necessary to prevent permanent disability or death.[ncbi.nlm.nih.gov]
  • In patients with unexplained anion and osmol gaps, early diagnosis and therapy with ethanol and hemodialysis help prevent the toxic manifestations of ethylene glycol poisoning.[ncbi.nlm.nih.gov]
  • Ethylene glycol poisoning is an important toxicological problem in medical practice because early diagnosis and treatment can prevent considerable morbidity and mortality.[ncbi.nlm.nih.gov]
  • It is proposed that early ethanol therapy may prevent the formation of ethylene glycol metabolites to the extent that calcium oxalate crystalluria is not seen.[ncbi.nlm.nih.gov]

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