Ethylene Glycol intoxication with and without simultaneous diabetic ketoacidosis: A report of nine cases and review of the literature

Abstract

Objective: To describe the clinical and biochemical observations made on nine patients with ethylene glycol intoxication(EGI) of whom five presented with simultaneous diabetic ketoacidosis (DKA). Methods: A retrospective chart search fordischarge diagnosis including the term ethylene glycol intoxication was conducted at University Hospitals of ClevelandInformation Services (Cleveland, OH) from 1986 through 1998. Nine (N=9) patients were identified and subsequentlydivided into two Groups (A & B). Group A included 5 patients with both DKA and EGI. Group B included 4 patients withEGI without DKA. Clinical manifestations and laboratory tests are summarized for both Groups. Serum specimens for allpatients were analyzed for ethylene glycol, propylene glycol, methanol, serum ketones, glucose, pH, electrolytes, liver andkidney function tests, lipase, amylase, cholesterol, triglycerides, C-peptide and glycosylated Hb. Results: Group A patientspresented with more severe hyperglycaemia accompanied by increased insulin requirements, glucose toxicity, more severeosmotic diuresis induced severe dehydration, pre-renal azotemia, transient rhabdomyolysis and hypertriglyceridaemia. Theiracute renal failure was fully reversible upon discharge. Finally, the length of hospital stay of patients in Group A wassignificantly longer than that of Group B patients, although mortality rate was reduced. Permanent and irreversible kidneydamage requiring haemodialysis was seen in all Group B patients. Conclusions: severe DKA presenting with simultaneoushigh anion and osmolal gap should prompt suspicion to the hypothetical concomitant EGI, particularly in those patients witha history of alcoholism, depression and past suicidal attempts.