Glycol Poisoning Research Articles

Current status of research on the diagnosis and treatment of acute ethylene glycol poisoning

Acute ethylene glycol poisoning often leads to acute kidney injury, and delays in diagnosis and treatment can lead to severe multi-organ dysfunction and even death. At present, there is a lack of specific laboratory tests that can be used for rapid clinical diagnosis, and diagnosis and evaluation only rely on medical history, clinical symptoms, and non-specific laboratory test results. Key treatments include alcohol dehydrogenase inhibitors (fomcpizole or ethanol) and hemodialysis, which is not approved in China. A clear understanding of the mechanism of toxicity, pathophysiology, clinical manifestations, efficacy and limitations of laboratory tests, and treatment options after ethylene glycol poisoning can help accelerate the early diagnosis, treatment, and prognosis of patients after ethylene glycol poisoning. This article reviews this article in order to provide a reference for clinicians.

Multiorgan Crystal Deposition in Acute Ethylene Glycol Toxicity.

Ethylene glycol (EG) is a widely available chemical and a well-known toxin in forensic pathology, which can lead to severe metabolic acidosis and death. Its metabolism in the body leads to formation of calcium oxalate (CO) crystals, which can precipitate in the kidney leading to renal failure. Although the identification of CO crystals in the kidney is widely known, the deposition of CO crystals in other organs has only occasionally been reported and seldom studied. This report examines 18 deaths due to EG toxicity for the presence of CO crystals in various organs. CO crystals were identified most often in the kidneys, followed by the brain and lungs. It is hypothesized that crystal deposition in these other organs may contribute to the toxicity of EG.

Suggested guide to using lactate gap as a surrogate marker in the diagnosis of ethylene glycol overdose.

Ethylene glycol (EG) poisoning, if not diagnosed rapidly, can lead to poor patient outcomes. Gas Chromatography (GC) is primarily used for EG quantitation which is rarely available, and the turn-around time may be prolonged. Most lactate results from point-of care (POCT) methods are falsely elevated in EG poisoning compared with automated chemistry analyser results. In combination the lactate gap (POCT-Automated chemistry) can be used as surrogate marker in just about all laboratories to indicate likely EG toxicity and guide treatment. A male presented by ambulance to hospital with severe agitation requiring mechanical ventilation to facilitate ongoing management. Venous blood gas analysis confirmed a high anion gap metabolic acidosis (HAGMA) with an elevated lactate. The lactate and osmolarity measured in the laboratory showed a normal lactate and high osmolarity, giving a large osmolar gap. The patient was immediately commenced on renal replacement therapy for presumed EG poisoning to minimize kidney injury, and the treatment continued for 19 hours. A very high EG concentration was confirmed by GC the next day. An elevated lactate gap along with a HAGMA and osmolar gap can provide rapid surrogate laboratory data indicating EG poisoning enabling timely treatment and better patient outcomes.

Lactate Gap: A Diagnostic Clue for Diagnosing and Managing Ethylene Glycol Poisoning

Lactate Gap: A Diagnostic Clue for Diagnosing and Managing Ethylene Glycol Poisoning

Ethylene Glycol Poisoning with Acute Liver Injury Due to Delayed Diagnosis: An Autopsy Case Report and Literature Review

Ethylene glycol (EG), commonly used as antifreeze, is frequently ingested accidentally or in suicides, and causes acute renal failure. We report an unusual case of EG poisoning with acute liver injury. After vomiting and loss of consciousness, a 48-year-old male was admitted to the emergency room. Despite prompt conservative treatment for metabolic acidosis, kidney function deteriorated, necessitating the continuous renal replacement therapy. Blood toxicology results, showing EG levels of 510 mg/L, arrived 10 hours after admission. Oral ethyl alcohol therapy commenced 16 hours post-admission. By 36 hours, liver function tests indicated significant liver damage, and the patient died 45 hours upon admission. On autopsy, histological findings were hepatic centrilobular necrosis, cerebral perivascular neutrophilic and lymphocytic infiltration with calcium oxalate deposition, and renal tubular necrosis with calcium oxalate deposition. EG concentrations in the blood and gastric contents were 18.7 mg/L and 45.0 mg/L, respectively. Glycolic acid and oxalic acid, metabolites of EG produced by alcohol dehydrogenase in the liver, cause metabolic acidosis, renal tubular calcium oxalate deposition, and acute renal failure, leading to death. Generally, because fomepizole or ethyl alcohol block alcohol dehydrogenase in the liver, acute liver injury by EG poisoning is rare. To the best of authors’ knowledge, only one relevant report was found in the literature described a case in which EG caused centrilobular necrosis in liver. In the current case, delays in diagnosis and antidote therapy without gastric lavage allowed continued metabolism of EG which led to acute liver injury and acute renal failure.

Novel Technique for Simultaneous Ethylene Glycol and Its Metabolites Determination in Human Whole Blood and Urine Samples Using GC-QqQ-MS/MS.

Toxicological analyses often necessitate the identification of compounds belonging to diverse functional groups. For GC-MS analyses, derivatization of compounds belonging to different functional groups can pose a challenge and requires the development of comprehensive methods of analysis. One example could be ethylene glycol, whose widespread use is related to possible unintentional or suicidal intoxications. This fact clearly indicates the need to develop sensitive methods for the determination of ethylene glycol and its metabolites in biological material, as only such complex analysis allows for proper toxicological expertise. A simultaneous GC-QqQ-MS/MS method for the determination of ethylene glycol together with its metabolites, glyoxal and glycolic acid, as well as the detection of glyoxylic acid and oxalic acid, was developed and fully validated. A novel approach for simultaneous derivatization of substances from different groups (alcohols, aldehydes, and carboxylic acids) was established. Sample preparation included the addition of three internal standards (BHB-d4, ethylene glycol-d4 and methylglyoxal), precipitation with acetonitrile and subsequent derivatization with N-tert-butyldimethylsilyl-N-methyltrifluoroacetamide (MTBSTFA), as well as pentafluorophenylhydrazine (PFPH). Detection was carried out with the use of triple quadrupole mass spectrometer. The ionization method was electron impact, and quantitative analysis was carried out in multiple reaction monitoring mode. The lower limit of quantification was 1 μg/mL, 0.1 μg/mL, and 500 μg/mL for ethylene glycol, glyoxal, and glycolic acid, respectively. The presented method was applied in three authentic postmortem cases of ethylene glycol intoxication.

Clinical manifestations and renal pathology of ethylene glycol.

Ethylene glycol (EG) poisoning is a critical medical emergency often associated with suicide attempts in adults. EG is metabolized by alcohol dehydrogenase, leading to the formation of toxic metabolites that cause metabolic acidosis, renal failure, hypocalcemia, aciduria, and disorders of the central nervous and cardiovascular systems. Calcium oxalate, a metabolite of EG, contributes to acute tubular necrosis. Despite limited reports on human renal pathology, we present a case detailing renal pathology following EG ingestion. A 44-year-old male, admitted due to loss of consciousness, had ingested a lethal dose of EG. Blood tests indicated metabolic acidosis, while urinary examination revealed calcium oxalate crystals. Continuous renal replacement therapy corrected the acidosis; however, nephrogenic diabetes insipidus subsequently developed. A renal biopsy on day 31 revealed calcium oxalate crystal deposition and tubulointerstitial damage. Notably, various stages of crystal deposition, adherence, and degradation were observed. This case underscores the importance of considering EG poisoning in cases of unexplained metabolic acidosis and renal dysfunction, with renal biopsy serving as a valuable diagnostic tool. Understanding the renal effects of EG is essential for timely intervention and effective management of poisoning cases.

Real-world safety and effectiveness of intravenous fomepizole in patients with ethylene glycol and methanol poisoning in Japan: results of a 7-year post-marketing surveillance study

ABSTRACT Background Fomepizole is a competitive alcohol dehydrogenase inhibitor used for the treatment of ethylene glycol and methanol poisoning. We evaluated the safety and effectiveness of fomepizole in patients with ethylene glycol or methanol poisoning in Japan. Research design and methods This retrospective post-marketing surveillance study conducted in Japan registered patients who received fomepizole intravenous infusion per the package insert (January 2015−June 2022). Endpoints included adverse drug reactions/infections (ADRs), arterial blood pH, and treatment outcomes. Results Of 147 patients registered (91 institutions), 131 and 126 were included in the safety and effectiveness analysis sets, respectively. Mean age was 43.6 years, and 66.4% were male. Mean time from poison ingestion to treatment was 15.1 hours; 66.4% received concomitant hemodialysis. No serious ADRs were reported. ADRs were reported in seven patients; the most-reported ADR was vomiting (2.3%). Seven patients died, 105 survived without sequelae, and 19 survived with sequelae. Most common sequelae were renal failure or renal dysfunction. Mean arterial blood pH increased to 7.4 by 4 hours of treatment, remaining stable for 24 hours post-treatment. Conclusions Fomepizole is well tolerated and helps improve clinical outcomes in patients with ethylene glycol or methanol poisoning in Japan. Trial registration Japanese Pharmaceutical Information Center (JapicCTI-152817).

Ethylene glycol intoxication: mind your gap(s)!—a case report

Ethylene glycol intoxication: mind your gap(s)!—a case report

Ethylene Glycol Toxicity and Its Therapy Management: A Literature Review

Background: Ethylene glycol (EG) is an antifreeze substance commonly used as an additive for syrup preparations. One of the detrimental effects caused by EG toxicity is acute renal failure (ARF) and death, assuming therapy and management are delayed. Presently, there are limited studies on toxicity of EG and therapy. Therefore, this study aimed to provide an overview of EG toxicity levels, clinical manifestations, arising reactions, and therapy management methods.Objectives: A narrative review design was employed with data collected from PubMed and Google Scholar. The strategy used keywords such as “ethylene glycol toxicity” and "acute renal" with the assistance of Boolean operators including AND and OR.Methods: The result showed that the minimum EG level for toxicity was at 22 mg/dL, followed by metabolic acidosis with an increased anion gap (>10mmol/L). Based on case reports from one experimental study, the clinical manifestations of patients experiencing EG poisoning included decreased consciousness, tachycardia, and coma, with ARF occurring after 24-72 hours.Results: Write study findings in this section.Conclusion: EG poisoning could cause kidney damage in the form of ARF and lead to death, assuming therapy was delayed. Presently, the most effective therapy for EG poisoning was fomepizole.

N-doped clay-like Ti3C2Tx MXene/N-doped CNTs composites for ethylene glycol detection in ambient air and exhaled breath

Ethylene glycol is odorless and harmful to humans. Each year, a large number of fatal cases are caused by ethylene glycol poisoning. Therefore, rapid identification of ethylene glycol is crucial. In this study, clay-like Ti3C2Tx MXene exhibits a larger interlayer spacing compared to accordion-like Ti3C2Tx MXene, which enhances the gas diffusion channels. Nitrogen doping can increase the active sites of clay-like Ti3C2Tx MXene. The introduction of nitrogen-doped carbon nanotubes into N-Ti3C2Tx was carried out to enhance selectivity towards ethylene glycol, leading to the formation of N-Ti3C2Tx MXene/N-CNTs. The N-Ti3C2Tx MXene/N-CNTs exhibits significant selectivity towards the ethylene glycol at room temperature. Meanwhile, the detection limit was 0.3484 ppm, with a shortened response/recovery time of 10.57/6.29 s. Meanwhile, the ethylene glycol sensor device has been prepared through custom-made circuit boards and sensing programs. Moreover, the adsorption and oxidation process of ethylene glycol on N-Ti3C2Tx MXene/N-CNTs was explored through in-situ infrared spectroscopy testing. This study revealed that the oxygen vacancies on the surface of N-Ti3C2Tx MXene/N-CNTs play a crucial role in the oxidative catalytic detection of ethylene glycol. The strategy of N-Ti3C2Tx MXene/N-CNTs provides a new avenue for the detection of ethylene glycol.

Nefrose por oxalato de cálcio em gato

The aim of this study was to report a case of sudden death due to acute renal failure by oxalate calcium nephrosis. Among the main differential diagnoses, there are ethylene glycol intoxication, lily intoxication and primary congenital hyperoxaluria. Epidemiology and clinical signs suggest intoxication by ethylene glycol, a nephrotoxic substance present in several products. There are few reports of this condition in Brazil, and it should be considered in cases of renal failure and sudden death.

THE TERATOGENIC EFFECT OF DIETHYLENE GLYCOL (DEG) ON FETUS MORPHOLOGY IN WHITE MICE (MUS MUSCULUS L.)

Objective: Diethylene glycol is listed in the Inventory of Cosmetic Ingredients as a solvent, viscosity controller, and fragrance. Most of diethylene glycol's toxicity is caused by ingesting the contaminated product. This study aims to determine the effect of a teratogen caused by diethylene glycol on mice fetuses.
 Methods: In this study, 20 mice were used, which were divided into four groups. Diethylene glycol was given with three variations of doses 1662.5, 3325, and 6650 mg/kgBW during the organogenesis period, day 6-15. The effects of teratogens observed were maternal body weight, fetal body weight, and number of fetuses, which were analyzed using one-way ANOVA, as well as morphological and skeletal abnormalities, which were analyzed descriptively.
 Results: Based on the results of the study, there was a significant difference in the body weight of the mice given diethylene glycol and the control group (p<0.05). There was no significant difference in body weight and the number of fetuses in the control and treatment groups (p>0.05). On the results of fixation of Bouins' solution, defects in the form of hemorrhage, resorption sites, and slow growth were found. At the same time, the results of the fixation of alizarin red solution found defects in the sternal, nasal, caudal, metacarpal, metatarsal, and phalanges bones.
 Conclusion: The conclusion based on the research is that diethylene glycol has the potential to provide teratogenic effects on mouse fetuses.

Ethylene glycol toxicity in two calves

Burdur Mehmet Akif University Veterinary Faculty Animal Hospital was brought from livestock to 3 calves aged between 15 and 20 days with complaints of weakness, dehydration, inability to get up and nervous findings. Two of them failed the treatment and were brought to the pathology department after being euthanized. Both animals were macroscopically dehydrated, cachectic, and had hair loss in some parts of the body. There was 1-2 liters of white light-colored transparent fluid in the abdominal cavity. Many organs and serous membranes in the abdominal cavity were hyperemic. Histopathological examination revealed bleeding, edema and degenerative changes in the heart, lungs and kidneys. Calcium oxalate crystals were found in many tubuler lumens, especially the proximal convoluted tubules in the kidneys. In the light of clinical, macroscopic, and histopathological findings, the case was diagnosed with ethylene glycol toxicity. Ethylene glycol toxicity is often seen in cats and dogs living near industrial or auto car repair shops, and in animals that accidentally drink antifreeze waste. This case report is the first case of ethylene glycol toxicity reported in livestock calves in Türkiye.

Ethylene Glycol Toxicity in The Emergency Department: A Diagnostic Challenge

Ethylene Glycol Toxicity in The Emergency Department: A Diagnostic Challenge

A retrospective analysis of toxic alcohol poisoning

Purpose: This study aimed to compare the clinical features of methanol and ethylene glycol poisoning.Methods: This single-center retrospective observational study included patients with toxic alcohol poisoning who visited a regional emergency medical center. Patients with methanol and ethylene glycol poisoning from January 2004 to June 2023 were selected for the study using diagnostic codes.Results: Twenty-two patients with toxic alcohol poisoning visited during the study period, with 11 patients for each category. Compared to methanol poisoning, ethylene glycol poisoning patients were more likely to have consumed alcohol for suicidal purposes (n=4 [36.36%] vs. n=8 [72.73%]) and were more likely to be drowsy (n=0 vs. n=6 [54.55%], <italic>p</italic>=0.016). The anion gap (25.43±8.35 mmol/L vs. 13.22±6.23 mmol/L, <italic>p</italic>=0.001) and lactic acid levels (1.785 [1.3–2.785] mmol/L vs. 9.90 [4.20–11.81] mmol/L, <italic>p</italic>=0.007) were higher in ethylene glycol poisoning patients than in methanol poisoning patients. Among alcohol dehydrogenase blockers, oral ethanol was administered to 10 patients (45.45%) (n=4 [36.36%] vs. n=6 [54.55%]), and intravenous ethanol was administered to six patients (n=4 [36.36%] vs. n=2 [18.18%]). Fomepizole was administered to two patients (9.09%) each, and renal replacement therapy was non-significantly more common in patients with ethylene glycol poisoning (n=8 [72.73%] vs. n=3 [27.27%], <italic>p</italic>=0.128). Three patients had delays in diagnosis and treatment, and while there were no fatalities, one patient was left with permanent vision damage.Conclusion: Because these are uncommon types of poisoning and the clinical presentation is difficult to recognize early, healthcare providers should be familiar with toxic alcohol types and screen for them to ensure proper diagnosis and treatment.

Methanol Poisoning: A Diagnostic Challenge in High Anion Gap Metabolic Acidosis

A 47-year-old gentleman was admitted with decreased responsiveness and vomiting. Clinically, he had altered mental status, pupils sluggish to light and laboured breathing. Thoracoabdominal examination and computed tomography of the brain were normal. Preliminary laboratory testing revealed high anion gap metabolic acidosis (HAGMA). Blood acetaminophen and urine paraquat were negative. Serum salicylate was not measured however respiratory alkalosis typical of salicylate intoxication was absent. Normoketonaemia and normoglycaemia rendered diabetic ketoacidosis improbable, whilst uraemia was ruled out as renal profile was only moderately impaired. Raised plasma lactate was inadequate to account for the magnitude of HAGMA, leading to a suspicion of ethylene glycol or methanol poisoning. Despite early treatment with intravenous ethanol, the patient died at day three of admission. Blood methanol concentration which was obtained on admission and reported three days later by the referral toxicology lab affirmed the diagnosis of methanol poisoning. Methanol poisoning can be challenging in situations where patient is obtunded and methanol analysis not widely available.

Urine fluorescence in suspected ethylene glycol intoxication

Urine fluorescence in suspected ethylene glycol intoxication

Successful treatment of late obstetric ethylene glycol intoxication with ethanol via the enteral route: a case report

Successful treatment of late obstetric ethylene glycol intoxication with ethanol via the enteral route: a case report

Emerging progressive atypical acute kidney injury in young children linked to ethylene glycol and diethylene glycol intoxication.

There had been a sudden surge of unusually severe and rapidly progressing acute kidney injury (AKI) incidence in Indonesia since August 2022 which did not correspond to the rise of COVID-19 incidence. We suspected this was related to ethylene glycol (EG) and diethylene glycol (DEG) intoxication. This study is aimed at describing the clinical and laboratory characteristics of AKI related to D(EG) intoxication in order to spread awareness of the possibility of intoxication in cases of rapidly progressing AKI with unknown etiology. We conducted a cross-sectional study by collecting secondary data from the pediatric AKI registry at a national referral hospital in Jakarta, Indonesia. Data on children admitted from January to November 2022 with diagnosis of stage 3 AKI based on KDIGO criteria were included. Data regarding demographics, symptoms prior to anuria, laboratory results, infection panel including COVID-19 status, treatment administered, and mortality were analyzed. Sixteen patients tested positive for EG and DEG, all with history of consuming syrup-based medications. High anion gap metabolic acidosis was observed in majority of patients with mean pH 7.33 ± 0.07 and mean anion gap 15.6 ± 7.8mEq/L. No patient had high osmolal gap (mean osmolal gap 3.46 ± 4.68). One deceased patient, who had kidney biopsy performed, showed severe damage and calcium oxalate crystals in the kidney tissue. Mortality was recorded in six patients (37.5%). Careful history taking of patient's clinical course, including consumption of syrup-based medications and laboratory findings, might aid clinicians to establish a working diagnosis of D(EG) intoxication without needing to wait for blood toxicology test. Early diagnosis and therapy are crucial to prevent substantial mortality.