Ethylene glycol (EG), a widely used industrial compound, has been implicated in accidental poisoning and homicide. Although the nephrotoxic mechanisms of EG are well characterized, its acute hepatotoxic potential remains underexplored.This study investigated histopathological and molecular alterations in the liver of rats following acute administration of EG. Possible dysfunction of an anti-oxidative pathway involving ferroptosis (glutathione peroxidase 4, Gpx4; solute carrier family 7 member 11, SLC7A11) is also examined. Male rats (8-week-old, male) were orally administered EG (8g/kg) and euthanized at 2 and 5days post-exposure by an administration of an overdose of anesthetic (40mg/kg sodium pentobarbital). Serological analysis was performed to assess liver function. Liver tissues were evaluated by histology, transmission electron microscopy, and transcriptome analysis. Serological findings indicated transient liver damage at 2days post-exposure, followed by recovery at 5days. Transmission electron microscopy revealed glycogen accumulation, corroborated by periodic acid-Schiff and periodic acid-methenamine silver staining. Histological analysis revealed an increased number of nucleoli, correlating with upregulation of ribosomal genes on microarray analysis, particularly at 5days post-exposure. In addition, significant decreases in Gpx4 and SLC7A11 expression were observed in rat livers treated with EG and Huh-7 human hepatoma cells, suggesting reduced cellular antioxidative capacity as a contributing factor to transient liver damage. These findings reveal a pathway underlying EG-induced transient liver damage and suggest a possible mechanism of recovery, thereby providing new insights into EG poisoning.

Ethylene glycol (EG) is a cheap available solvent used mainly as antifreeze and in resin industry while diethylene glycol (DEG) is usually used in natural gas industry. In the past few years there was increasing reports about EG and DEG intoxication especially in Indonesia, Uzbekistan, Panama, India, Gambia and some African countries. The intoxication was due to using some pediatric cough syrups that are contaminated with these harmful solvents which lead to acute renal failure and death in some cases. World Health Organization declares that any limit of EG or DEG more than 0.1% considered a safety issue in the pharmaceutical products. In 2023, random pharmaceutical samples from Iraqi local market were tested by independent US laboratory (Valisure LLC) and there was an EG contaminated cough syrup with approximately 21 times more than the accepted limits. The above report encourage the conduction of this research to investigate the presences and the amount of EG and DEG in cold and cough syrups available in the Iraqi markets. In this study, 12 samples of cold and cough pediatric syrups of different origin were collected from the local market in Iraq and the levels of EG and DEG were measured by using gas chromatography with flame ionization detection (GC-FID) to estimate the presence and concentration of these compounds in the selected drugs. The results showed that only one sample was containing 0.65% DEG , while other samples were containing less than 0.1% or undetectable levels of either EG or DEG.

ABSTRACTEthylene glycol (EG) is a hazardous alcohol present in various household and industrial products. After being metabolized by ethanol dehydrogenase and aldehyde dehydrogenase, it can produce glycolate, acetaldehyde, and oxalate, leading to acute kidney injury. Renal failure is mainly caused by tubular damage induced by metabolites such as glyoxylate and oxalate, and may also be related to tubular obstruction caused by oxalate crystal precipitation. A 35‐year‐old Chinese man was brought to the emergency department in an unconscious state with a suspected history of EG ingestion. Laboratory examination revealed significant metabolic acidosis with elevated anion gap, acute kidney injury, and hyperkalemia, suggestive of possible EG poisoning. Renal biopsy revealed acute tubular necrosis, with numerous oxalate crystals forming in the tubules of the patient, confirming the diagnosis of EG poisoning with oxalate nephropathy. Treatment included fluid resuscitation, bicarbonate therapy, ethyl alcohol administration, and hemodialysis. After early and active treatment, the patient's consciousness recovered, acidosis improved significantly, and no further dialysis treatment was required.

Background:Ethylene glycol is a colorless, odorless, sweet-tasting liquid commonly found as an industrial solvent. It is also used as an antifreeze in cooling and heating systems, hydraulic brake fluids, industrial humectants, and the paint and plastics industries, as well as an electrolytic condenser. Its sweet taste and odor make it particularly dangerous for accidental ingestion by children and pets, which may result in toxicity and death.Aim:The aim of this study was to evaluate the protective or ameliorative role of Alcea rosea root extract on rats exposed to ethylene glycol (EG) toxicity.Methods:A total of 40 male Wistar rats were divided into 5 groups. The first group was kept as a control. The second and third groups were exposed to doses of 0.4% (v/v) and 0.75% (v/v) EG, respectively, for 28 days. Animals in groups IV and V, in addition to EG, were treated with 170 mg/kg/day of A. rosea root extract for 28 days. Blood and tissue samples were collected from each animal and subjected to hematological, biochemical, and histopathological investigations.Results:There was an increase in the body weight of experimental animals on days 14 and 28 compared with the control group. On day 14, there was an increase in the Packed Corpuscular Volume and Red Blood Corpuscles values in animals exposed to EG, which was improved with the addition of A. rosea. Significant decrease in the mean corpuscular volume of animals exposed to EG, as well as those treated with A. rosea extracts. However, the values of animals in groups IV and V showed an increase compared to the values obtained from groups II and III. Kidney function tests were indicated by an increase in blood urea nitrogen, creatinine, and uric acid concentrations in the serum, both at day 14 and day 28. The three analytes increased in experimental animals in groups II and III, whereas in groups IV and V, the values were lower than those in groups II and III. The same applies to the liver enzymes aspartate aminotransferase and alanine aminotransferase, which are markers for liver function. They increased in experimental animals, and the animals in groups IV and V showed values that were lower than those obtained from groups II and III. It was concluded that A. rosea root extract has an ameliorative effect on experimental animals exposed to EG toxicity for 28 days. Histopathological changes in the kidneys and livers were consistent with biochemical changes, indicating liver and kidney impairment, which improved with the addition of A. rosea in groups IV and V.Conclusion:Ethanolic extract of A. rosea root resulted in the improvement of toxicity in rats exposed to ethylene glycol for 28 days. The improvement was indicated by hematological, biochemical, and histopathological changes.

This case report describes a male in his early 40s presenting with severe ethylene glycol (EG) poisoning from antifreeze ingestion, marked by profound metabolic acidosis, hyperkalaemia and multi-organ failure. The patient was found unconscious in the garage with shallow breathing and hypothermia, progressing to critical illness despite aggressive resuscitative measures. Diagnostic evaluations revealed high anion gap metabolic acidosis, elevated lactate, hyperkalaemia and a high osmolal gap, confirmed to be due to EG toxicity. Immediate interventions included continuous renal replacement therapy, mechanical ventilation and supportive care, alongside bicarbonate therapy and broad-spectrum antibiotics. However, the patient deteriorated rapidly, developing fixed dilated pupils, cerebral oedema and eventual death on the third day of admission. This case highlights the diagnostic and therapeutic challenges of managing severe toxic EG poisoning in critically ill patients and underscores the importance of early recognition and intervention to improve outcomes.

Simple SummaryAnimal abuse is a serious and underreported problem, with cats, particularly those living in colonies, being frequent victims. In Spain, reliable data on feline abuse are limited. This study evaluated the cause, manner and mechanisms of death from 53 cats over five years at the Pathology and Forensic Veterinary Unit of the VISAVET Health Surveillance Center in Madrid (Spain). More than half of the cats died from non-natural causes, including blunt force trauma, poisoning, and projectile injuries, while the remaining cats died from natural causes. Compared to a previous regional study, suspected abuse cases have increased, including new instances of antifreeze poisoning. These findings provide insight into trends in feline abuse and underscore the need for improved detection, prevention, and professional awareness to protect vulnerable animal populations. Feline colonies continue to be a point of societal conflict, and forensic evidence suggests that they are a primary target for this type of abuse.Despite the well-established link between animal abuse and interpersonal violence, animal mistreatment remains a global issue. Challenges such as inconsistent legislation, limited training of specialized pathologists, and lack of regional data persist and must be addressed. In Spain, the real incidence of animal abuse is unknown, and the literature on the topic remains scarce. This study aims to assess the evolution of feline abuse cases in the Community of Madrid, Spain, since the publication of a previous study in the same region. Over a five-year period (2020–2024), 53 cats with suspected abuse were diagnosed at the Pathology and Forensic Veterinary Unit of the VISAVET Health Surveillance Center. Thirty-one cats (58.49%) died from non-natural causes: 17 (32.07%) due to blunt force trauma, eight (15.09%) due to poisoning, and six (11.32%) due to projectile injuries. Natural causes accounted for 21 cases (39.62%). Compared to the previous study, data suggest a possible upward trend in the number of cats referred with suspected animal abuse, including eight new cases of ethylene glycol poisoning. The correlation between the type of suspected abuse and final diagnosis was very low. This article examines current challenges related to animal violence, with particular emphasis on feline colonies, and promotes awareness among both veterinary and non-veterinary professionals.

Abstract Background Numerous papers have noted the difference in measurements of lactate across different platforms that can occur in ethylene glycol (EG) poisoning, due to method-dependent degree of interference of the glycolic acid (GA) metabolite of EG. This is known as the “lactate gap”. Given non-linearity of GA interference for the Roche Cobas lactate assay, we investigated whether such non-linearity might itself be used as an aid to diagnosis of EG poisoning. Methods Lactate concentration ([LAC]) measurements were made on the Roche Cobas c502 analyzer for serial dilutions (relative concentrations of 1, 0.75, 0.5, 0.25) of a pooled plasma (Li-heparin) sample spiked with 0, 5, 10, or 20 mmol/L GA, using saline as a diluent. Experiments were conducted in triplicate. Results Results of a representative experiment are shown in Figure. In this example, for the unspiked pooled plasma sample ([LAC]=4.3 mmol/L; reference interval=<2.2 mmol/L), the dilution curve was linear, as is observed for all LAC samples within the assay’s linear range (<20 mmol/L). For spiked samples, dilution curves were patently nonlinear for [GA] = 10 or 20 mmol/L. For instance, for [GA] = 10 or 20 mmol/L, Y-axis intercepts for 2-point curve segments, based on results for dilutions of 1.0 and 0.75, were significantly higher than zero (p < 0.05), whereas zero is the expected result for any segment of a dilution curve having no interference. Conclusions Non-linearity of a saline dilution series for [LAC] as shown using the Roch Cobas LAC assay is characteristic of positive assay interference by GA. In the context of investigation of possible EG poisoning, with an elevated anion gap characteristic of presence of GA, non-linearity of low dilutions (1, 0.75) in the Roche lactate assay for an elevated lactate result may specifically suggest presence of GA for GA >= 10 mmol/L.

Abstract Background Ethylene glycol (EG) is a toxic alcohol in products such as antifreeze. Its sweet taste often leads to accidental or intentional ingestion, particularly among individuals with alcohol addiction. EG poisoning affects multiple organ systems and can result in metabolic acidosis, ataxia, and even death. Recently, there has been growing clinical interest in an enzymatic automated assay, driven by cautious consideration due to the limited knowledge of its performance compared to chromatographic methods. Moreover, there is limited data about EG stability in biological samples under different pre-analytical conditions. This study aims to investigate the impact of various factors, including collection tube type, handling methods, and time, on the stability of ethylene glycol in blood and serum samples. Additionally, it seeks to compare the performance of an automated enzymatic assay with gas chromatography-mass spectrometry (GC-MS). Methods This multi-part study was conducted at the University of Kentucky emergency department laboratory. These studies used six types of vacuum blood collection tubes with varying additives or gel separators. Samples were spiked with low (30 mg/dL) and mid (300 mg/dL) EG concentrations. Four experimental setups were employed: (1) Vacuum Tube Validation to compare tube types, (2) a 24-hour Stability Study with timed intervals of analysis, (3) an Unspun Study examining samples left uncentrifuged for up to four hours, and (4) a comparison between manual and pneumatic tube system (PTS) delivery methods. Assays were conducted using the Catachem enzymatic kit on the Cobas 6000 501c analyzer, and results were cross-verified with GC-MS. Over an 18-month period, we also monitored the in-house application. We verified all samples with concentrations between 5–24 mg/dL or those showing interference, as indicated by the kinetic curve, using GC-MS. Results EG stability was generally maintained across all conditions tested. In the 24-hour stability study, percent recovery differences spanned 0.5–19.6%, falling within the acceptable Total Error Allowable (TEa) of 25%. Light green and gold-top tubes demonstrated lower variability in the unspun study, with coefficients of variation (CV) under 2%. Comparisons between manual and PTS delivery yielded minimal variability (<2%) in analyte recovery, indicating negligible effects of the handling method. Notably, variability was more pronounced in low-concentration samples compared to mid-concentration samples, particularly in tubes with sodium heparin or EDTA additives. Out of 356 samples tested for EG using the enzymatic method, only 26 were positive. Among these, only two samples had concentrations above 10 mg/dL; these were the only samples that also tested positive by GC-MS. Conclusion This study establishes robust evidence for the stability of EG in blood and serum under varying conditions, providing crucial insights for clinical and forensic toxicology. It demonstrated that EG does not adhere to the gel layer in serum and plasma gel separator tubes. The findings validate the enzymatic assay as a rapid and automated alternative to GCMS for EG quantification. They also support establishing a lower limit for the clinical reportable range of 10mg/dL for the enzymatic assay, rather than using limit of quantification of 5 mg/dL.

Abstract Background The reference method to analyze ethylene glycol (EG) is Gas Chromatography (GC). However, GC instruments are not available in most clinical laboratories, causing EG testing to be sent out. This prolongs turnaround time and delays treatment, which is precarious given the short (30min-12hr) onset for life-threatening CNS and metabolic effects from EG intoxication. To address the need for acute determination of EG levels, we evaluated the analytical performance of Catachem’s EG open channel assay on a Beckman AU5800 chemistry analyzer in the core laboratory of Grady Memorial Hospital, a large safety-net provider of emergency care in Atlanta. Methods Assay linearity and analytical measurement range (AMR) were verified in triplicate using Catachem’s linearity material. Within-run and day-to-day precision (twice over 10 days) were tested using two Catachem controls. Analytical sensitivity was assessed by running blank and spiked patient samples with low EG concentrations in quadruplicate over 4 days. Limit of detection (LOD) was calculated as limit of blank + 1.65×standard deviation of low EG spiked samples. Limit of quantification (LOQ) was determined by the lowest EG concentration at which maximum allowable precision was 20%. Method comparison was performed using residual patient serum samples collected in serum separator tubes (n=35) and spiked with EG (Sigma-Aldrich, 5M solution) at concentrations spanning the AMR. An independent hospital lab offering the same Catachem EG assay configured on a Roche Cobas C502 served as the comparative method. A reference interval was determined from 30 patient serum samples with normal osmolality (272-297 mOsm/kg). Sample carryover was determined using patient samples spiked with high or low EG concentration according to the protocol described by EP Evaluator. To assess analytical specificity, 3 neat and 3 EG spiked patient samples were run in duplicate using methanol (99%, Cardinal Health), ethanol (95%, Pharmco), isopropanol (70%, Hydrox), and acetone (99%, Fisher) at final concentrations of 2000 mg/dL. No spike-ins changed sample volume by more than 5%. Results The assay was linear between 0-300.0 mg/dL (y-intercept of -2.8 mg/dL, slope=0.95). Precision studies using 2 levels of QC demonstrated a within run CV=1.6% for each level and day-to-day run CV=3.9% (mean=53.9 mg/dL) and 2.8% (mean=247.3 mg/dL). Total Allowable Error (TAE) for within-run and day-to-day precision were 5.0% and 6.7%, respectively. Limit of detection (LOD) and limit of quantification (LOQ) were 2.0 mg/dL and 4.0 mg/dL, respectively. Method comparison exhibits an allowable slope of 0.96, y-intercept of 2.0, correlation coefficient (r) of 0.99, and average bias of -1.4 mg/dL. Carry over error of -0.4mg/dL was below the error limit of 1.0mg/dL and not clinically significant. All 30 patient samples with normal osmolality resulted with EG concentrations

Ethylene glycol poisoning is a rare but life-threatening intoxication. Early diagnosis is often difficult, as the initial presentation resembles ethanol intoxication, while later stages are characterized by severe high–anion gap metabolic acidosis. Diagnostic challenges are compounded by the fact that glycolic acid, a toxic metabolite of ethylene glycol, may be falsely detected as lactate by blood gas analyzers. We report a 25-year-old man who ingested 500 mL of automobile antifreeze along with 10 fluoxetine tablets in a suicide attempt. He presented with dizziness, abdominal pain, agitation, and rapidly progressed to coma (Glasgow Coma Scale score 6). Laboratory tests showed severe metabolic acidosis (pH 7.09, HCO₃⁻ 3.2 mEq/L, anion gap 22.5 mEq/L), osmotic gap 83 mOsm/L, hyperlactatemia, hyperglycemia, mild hypocalcemia, and urinary calcium oxalate crystals. Immediate management included intravenous bicarbonate and calcium gluconate. Continuous hemofiltration was started shortly after admission to the intensive care unit, followed by conventional hemodialysis the next day. Since fomepizole was not available, ethanol was administered via nasogastric tube as an alternative antidote until fomepizole could be procured more than 20 hours after admission. Despite delayed antidotal therapy, the patient’s metabolic status improved and he was extubated on day 5. However, he developed acute kidney injury with persistent anuria, requiring ongoing dialysis. On day 8, he was transferred to his home country for continuation of renal replacement therapy. This case demonstrates the importance of early recognition of ethylene glycol poisoning through the combined assessment of anion and osmotic gaps. When fomepizole is not immediately available, ethanol remains a reliable substitute to delay toxic metabolism. Prompt initiation of supportive therapy and dialysis is crucial for survival, even in cases with delayed presentation and massive ingestion.

Purpose: This study describes the development of a virtual reality simulator to train medical staff responsible for acute poisoning in early diagnosis and treatment and presents an evaluation of its face and content validity.Methods: Five clinical toxicology experts identified calcium channel blocker poisoning, neuroleptic malignant syndrome, ethylene glycol poisoning, methemoglobinemia, and organophosphate poisoning as the focus of scenario development. A three-dimensional virtual reality environment was created using a video game engine, with interaction taking place via a head-mounted display and hand controllers. Emergency physicians assessed the simulator, and a questionnaire survey was conducted to evaluate its face and content validity using a 10-point scale. The collected data were descriptively analyzed.Results: Eighteen emergency physicians with an average age of 43.9 years old with 11.3 years of experience, evaluated the simulator. Thirteen (72.2%) had no prior experience with immersive virtual reality. The simulator’s realism and ease of operation were highly rated, averaging 9 points. The initial diagnosis and treatment training effectiveness, educational content clarity, and feedback were given scores of 10 points in some scenarios. The simulator’s usefulness as a training tool was rated 9 points. The lowest score (8 points) was given for clarity of interaction in four scenarios. Positive feedback highlighted the value of experiencing rare poisoning cases and receiving feedback on treatment.Conclusion: A virtual patient simulator with five scenarios was developed to train medical staff responsible for cases of acute poisoning in the initial diagnosis and treatment. Emergency physicians evaluated the simulator as realistic and stated that it would be effective in education.

ABSTRACTAn 8‐year‐old, 1.06 kg, male castrated, domestic ferret (Mustela putorius furo), was presented with an antifreeze (ethylene glycol) poisoning. The relevant medical history shows a T‐cell lymphoma diagnosed 8 months ago and was being treated with prednisolone. At the initial examination, an ataxic gait was noted and blood, urine and abdominal ultrasound tests were performed during the 48‐h hospitalisation. During hospitalisation, clinical examinations revealed ataxia, apathy, somnolence, hypothermia, salivation, vomiting, anorexia and anuria. Blood tests and ultrasound examinations revealed the development of azotemia with reduced urine‐specific gravity and loss of renal structure, with renal medulla and cortex no longer being differentiated. Treatment included ethanol infusion, metoclopramide, maropitant and furosemide. The ferret died of acute renal failure 48 h after initiation of therapy and autopsy confirmed antifreeze intoxication as the cause of death. Antifreeze poisoning in ferrets is underreported but possible. Prognosis is poor without immediate therapy.

Introduction. Ethylene glycol (EG) and diethylene glycol (DEG) are toxic compounds widely used in industry. They can contaminate pharmaceutical products due to the use of substandard excipients or deliberate adulteration. Their presence, even in small amounts, poses a serious risk to human health and life. The ingestion of such drugs, especially by children, can cause severe poisoning with damage to the kidneys, liver, and nervous system, and may even lead to fatal outcomes. Objective. The study aims to analyze historical cases of mass EG and DEG poisonings, investigate the causes of their presence in pharmaceuticals, and examine their toxicological properties, metabolic pathways, and clinical manifestations of intoxication. Materials and methods. The research utilized data from scientific publications, reports on mass poisoning incidents, investigations and regulatory documents. Results. The review provides characteristics of EG and DEG, their industrial applications, metabolic pathways, mechanisms of toxicity, and key symptoms of poisoning. It also explores the reasons for their presence in pharmaceutical products and historical cases of mass poisonings. Special emphasis is placed on the urgent need for enhanced quality control measures and implementation of high-sensitivity analytical methods to prevent future incidents. Conclusion. To minimize risks of repeated intoxications from EG or DEG -contaminated medications, it is essential to strengthen regulatory requirements and quality control systems, employ advanced analytical techniques, and improve international regulatory cooperation. A comprehensive approach incorporating these measures will enhance drug safety and prevent future poisoning cases.

Introduction. A number of excipients such as propylene glycol, sorbitol and glycerol used in the manufacture of soft dosage forms can be sources of toxic impurities of ethylene glycol and diethylene glycol. The content of these impurities must be controlled for the safe use of such pharmaceuticals. The high level of toxicity of ethylene glycol and diethylene glycol, low standards of their content, as well as the variety and complexity of the composition of dosage forms require the use of highly sensitive and selective analytical techniques. Objective. Development and validation of methods for quantitative determination of ethylene glycol and diethylene glycol by gas chromatography in five samples of soft dosage forms of different composition. Material and Methods. The object of the study was five samples of soft dosage forms. The composition of these pharmaceutical preparations includes propylene glycol and various macrogol compounds. Results. Methods of quantitative determination of ethylene glycol and diethylene glycol by GC-FID method in five samples of soft dosage forms of different composition were developed. It was demonstrated that the differences in the composition of the studied objects require an individual approach to the analysis of these impurities - selection of chromatographic columns and temperature regimes, allowing to separate the analyzed components from the drug matrix. The applicability of the developed analytical methods for quantitative determination of ethylene glycol and diethylene glycol in the studied preparations was confirmed within the framework of validation experiments. Conclusion. This study demonstrated the possibility of using the GC-FID method to control the content of impurities of ethylene glycol and diethylene glycol in five soft dosage forms of different composition.

Ethylene glycol poisoning is recorded in many countries of the world, but it is especially relevant in the Russian Federation, being one of the main reasons for hospitalization of patients with acute poisoning of chemical etiology. Ethylene glycol poisoning has severe medical, social and economic consequences.Purpose of the study: analytical toxicological analysis, features of diagnosis and intensive care of patients hospitalized with acute ethylene glycol poisoning in the toxicology center of a specialized hospital.Materials and methods of research. Medical documents of patients admitted to the Center for the Treatment of Acute Poisoning of the State Budgetary Institution of St. Petersburg Research Institute for Emergency Medicine named after. I.I. Dzanelidze in 2019–2022 with a diagnosis of «ethylene glycol poisoning.» ICD-10 rubric: T52.3. A statistical and chemical-toxicological study was carried out when patients were admitted to the hospital and over time after intensive care.Research results. According to the toxicological center of the State Budgetary Institution of St. Petersburg Research Institute of SP named after I.I. Dzanelidze, the number of patients with ethylene glycol poisoning was: 2019–1 admission; 2020–1 patient; 2021 — out of 2 patients admitted, 1 patient died; 2022 — out of 2 patients admitted with ethylene glycol poisoning, 1 patient died.All patients admitted with ethylene glycol poisoning were in critical condition with severe impairment of vital organs.Conclusion: ethylene glycol poisoning occupies one of the leading places among acute poisonings of chemical etiology in terms of the number of adverse outcomes. Characterized by severe medical, social and economic consequences.

Ethylene glycol toxicosis in 39 sport horses following ingestion of contaminated water: A case report.

BackgroundEthylene 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.Case ReportA man 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.ConclusionAn 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.

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.

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.

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