Abstract
BackgroundEthylene glycol is highly toxic and represents an important cause of poisonings worldwide. Toxicity can result in central nervous system dysfunction, cardiovascular compromise, elevated anion gap metabolic acidosis and acute kidney injury. Many states have passed laws requiring addition of the bittering agent, denatonium benzoate, to ethylene glycol solutions to reduce severity of exposures. The objectives of this study were to identify differences between unintentional and intentional exposures and to evaluate the utility of denatonium benzoate as a deterrent.Methods and FindingsUsing the National Poison Data System, we performed a retrospective analysis of reported cases of ethylene glycol exposures from January 2006 to December 2013. Outcome classification was summed for intentionality and used as a basis for comparison of effect groups. There were 45,097 cases of ethylene glycol exposures resulting in 154 deaths. Individuals more likely to experience major effects or death were older, male, and presented with more severe symptoms requiring higher levels of care. Latitude and season did not correlate with increased exposures; however, there were more exposures in rural areas. Denatonium benzoate use appeared to have no effect on exposure severity or number.ConclusionDeaths due to ethylene glycol exposure were uncommon; however, there were major clinical effects and more exposures in rural areas. Addition of denatonium benzoate was not associated with a reduction in exposures. Alternative means to deter ingestion are needed. These findings suggest the need to consider replacing ethylene glycol with alternative and less toxic agents.
Highlights
Ethylene glycol is a synthetic, colorless, and odorless liquid that tastes sweet and is used primarily to produce plastic containers and polyester fibers and secondarily as the main component in engine antifreeze [1]
Toxicity can result in central nervous system dysfunction, cardiovascular compromise, elevated anion gap metabolic acidosis and acute kidney injury
Toxicity occurs after enzymatic conversion of the parent alcohol to glycolic acid and oxalic acid, which both produce numerous clinical manifestations, including confusion, nausea, vomiting, central nervous system dysfunction, cardiovascular compromise, elevated anion gap metabolic acidosis, and acute kidney injury [6,7,8,9]
Summary
Ethylene glycol is a synthetic, colorless, and odorless liquid that tastes sweet and is used primarily to produce plastic containers and polyester fibers and secondarily as the main component in engine antifreeze [1]. Ethylene glycol is highly toxic and represents an important and persistent cause of intentional and unintentional poisonings worldwide [1,2,3,4,5]. Toxicity occurs after enzymatic conversion of the parent alcohol to glycolic acid and oxalic acid, which both produce numerous clinical manifestations, including confusion, nausea, vomiting, central nervous system dysfunction, cardiovascular compromise, elevated anion gap metabolic acidosis, and acute kidney injury [6,7,8,9]. Ethylene glycol is highly toxic and represents an important cause of poisonings worldwide. Toxicity can result in central nervous system dysfunction, cardiovascular compromise, elevated anion gap metabolic acidosis and acute kidney injury. The objectives of this study were to identify differences between unintentional and intentional exposures and to evaluate the utility of denatonium benzoate as a deterrent
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