Edit concept Question Editor Create issue ticket

Toxic Effect of Glycols


Presentation

  • All three patients had presented late ( 24–72 hours) with established renal failure.[emj.bmj.com]
  • Case presentation A 55 year-old male presented to a local emergency department in Panama with abdominal pain, vomiting and diarrhea. He had been using an prescription cough syrup in the preceding days to treat a viral illness.[calpoison.org]
  • A delay is present between ingestion and development of symptoms. Initial symptoms of ethylene glycol toxicity is typically a severe encephalopathy (similar clinically to acute basilar artery occlusion) 1.[radiopaedia.org]
  • Background: Ethylene glycol, present in antifreeze products, may be ingested accidentally or for the purpose of inebriation or suicide.[southtees.nhs.uk]
  • In developing its educational products ATSDR has made a diligent effort to ensure the accuracy and the currency of the presented information.[atsdr.cdc.gov]
Gastric Lavage
  • 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]
  • Ethylene glycol is rapidly absorbed from the stomach, making treatment with gastric lavage and syrup of ipecac ineffective. 3, 6 Likewise, it requires large amounts of activated charcoal to bind relatively small amounts of ethylene glycol, and the therapeutic[aafp.org]
Moonshine
  • A rarer place that a patient would consume methanol is in contaminated moonshine. Very rarely, inhalational and dermal exposures have been reported. Methanol is metabolized in the liver to formaldehyde by alcohol dehydrogenase.[emdocs.net]
Thrombosis
  • […] diagnosis is relatively broad, with imaging features and clinical presentation similar to a number of other conditions including: other toxic encephalopathies metabolic encephalopathies posterior reversible encephalopathy syndrome (PRES) deep cerebral vein thrombosis[radiopaedia.org]
Muscle Spasm
  • Effects of ingestion are inebriation, coma, seizures, meningismus, muscle spasms, and paralysis of the extraocular muscles. Also causes tachycardia, hyperventilation, ARDS, and heart failure.[emdocs.net]
Photophobia
  • Methanol leads to the classic “snowstorm” vision and also photophobia.[emdocs.net]
Renal Insufficiency
  • Predictors of Death and Prolonged Renal Insufficiency in Ethylene Glycol Poisoning. J Intensive Care Med. 2013 Dec 26. [Medline]. Ghannoum M, Hoffman RS, Mowry JB, Lavergne V.[emedicine.medscape.com]
  • When ingested in the form of antifreeze or other automotive products, ethylene glycol results in central nervous system depression, cardiopulmonary compromise, and renal insufficiency.[clinchem.aaccjnls.org]
  • These patients would require close monitoring for the development of renal insufficiency or acidosis.[renalandurologynews.com]
Anuria
  • If left untreated, patients may die within a week after the onset of anuria. Additionally, mild to moderate hepatotoxicity is often seen.[calpoison.org]
  • Most renal damage is reversible and renal recovery, which may take a few months, is the norm even after anuria.[renalandurologynews.com]
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]
  • 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.[clinchem.aaccjnls.org]
Myoclonic Jerking
  • jerks, tetanic contractions may occur.[southtees.nhs.uk]
  • jerks convulsions coma death Cerebral edema and deposition of calcium oxalate crystals in the walls of small blood vessels in the brain contribute to this CNS toxicity (Jobard, Harry et al. 1996; Bey, Walter et al. 2002; Tobe, Braam et al. 2002).[inspectapedia.com]
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.[clinchem.aaccjnls.org]
Stupor
  • Symptoms may include nausea, vomiting, convulsions, stupor (decreased level of alertness), or even coma.[medlineplus.gov]
Cerebellar Sign
  • It can cause hemorrhagic gastritis and profound inebriation with cerebellar signs and coma. Due to the acetone byproduct, the patient will sometimes have a fruity odor on their breath.[emdocs.net]

Workup

Pulmonary Infiltrate

Treatment

  • Treatment Current practice guidelines for initiating treatment of ethylene glycol poisoning have been published by the American Academy of Clinical Toxicology (AACT) 4 and are listed in Table 3.[aafp.org]
  • A new alcohol dehydrogenase inhibitor, fomepizole (brand name: Antizol), was approved in 1997 for the treatment of ethylene glycol poisoning in patients at least 12 years old. It has also been used successfully with younger children.[medicinenet.com]
  • The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber.[medicinesinpregnancy.org]
  • Serious effects of poisoning can be prevented if medical treatments are provided soon after ingestion. Top of Page Is there an antidote for ethylene glycol poisoning? Ethanol and fomepizole are used as antidotes in the treatment of EG poisoning.[acmt.net]

Prognosis

  • 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]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Dieu-Thu Nguyen-Khoa, MD; Vitamin K Deficiency; Etiology; Medscape Reference [ link ]. If push comes to shove, don't fight your doctors over this contentious topic — just refer them to these links. These references are as mainstream as it gets.[gutsense.org]

Epidemiology

  • 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]
  • Epidemiology According to the 2012 data from the United States Poison Control Center, 16,458 cases of isopropyl alcohol ingestions were reported. 8,773 of these cases were classified as a “toxicity” with 65 patients experiencing “major morbidity,” but[emdocs.net]
  • Epidemiology Frequency United States Ethylene glycol is a relatively common cause of overdose in US emergency departments.[emedicine.medscape.com]
  • It doesn’t take a PhD in epidemiology to infer a possible connection between these two happenings.[gutsense.org]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • Pathophysiology Methanol also called methyl alcohol is found in windshield wiper fluid, de-icing products, paint removers, photocopying fluid, shellacs, and embalming fluid.[emdocs.net]
  • 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]
  • Pathophysiology Toxicity results from the depressant effects of ethylene glycol on the central nervous system(CNS). Metabolic acidosis and renal failure are caused by the conversion of ethylene glycol to noxious metabolites.[aafp.org]

Prevention

  • These antidotes work by preventing the body from metabolizing EG into even more dangerous toxins. By stopping the breakdown of EG, further damage to the body may be prevented, but the antidotes do not reverse any damage that has already occurred.[acmt.net]
  • Early treatment with an antidote will prevent the production of toxic metabolites and prevent the rise in anion gap.Typically, after a brief period of inebriation due to the intoxicating effect of ethylene glycol itself, metabolic acidosis develops, followed[southtees.nhs.uk]
  • (NCHEC) CHES : The Centers for Disease Control and Prevention is a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc.[atsdr.cdc.gov]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!