Herein, we describe five micu patients who acquired severe propylene glycol toxicity due to iv lorazepam or diazepam administration. In cases of both accidental and purposeful ingestion, timely diagnosis of eg toxicity enables the administration of agents. The purpose of the current study was to determine if the catachem test kit catachem inc. The mechanism of toxicity is unknown but probably is different from oxalate toxicity associated with ethylene glycol poisoning.
Thought to result from calcium oxalate blocking the renal tubules. The early diagnostic and establishment of therapy are very. Dermal absorption is negligible and does not contribute significantly to systemic toxicity. Toxicity and death may occur after drinking even a. Management of patients with deg toxicity relies on early diagnosis with supportive and symptomatic care for multiorgan failure. Ethylene glycol itself is a colourless fluid although the solutions it is commonly found in are often coloured in an attempt to prevent accidental ingestion. The main sources of information for this fact sheet are epas integrated risk information system iris 7, which contains information on inhalation chronic toxicity of 2methoxyethanol, 2ethoxyethanol, and 2. Intoxication with ethylene glycol occurs as a result of intentional ingestion in suicide attempts or accidentally.
Ethylene glycol poisoning is poisoning caused by drinking ethylene glycol. Methanol and ethylene glycol are frequently found in high concentration in automotive coolantantifreeze and deicing solutions, windshield wiper fluid, solvents, cleaners, fuels, and other industrial products. Recent references from pubmed and vetmedresource richards l, ong h m, davis m, hodge p 2011 ethylene glycol toxicity in a cat. Treatment of ethylene glycol poisoning free full text. Initial symptoms of ethylene glycol intoxication 0. Ingestion of ethylene glycol eg is a frequently encountered toxicity in dogs and cats. Fomepizole, a new medica tion for ethylene glycol toxicity, has changed the management of this poisoning. It increases the elimination halflife of eth ylene glycol. Fomepizole for the treatment of ethylene glycol poisoning.
Preliminary evaluation of a quantitative ethylene glycol. Ethylene glycol consumed as concentrated solution of antifreeze or screenwash. In patients with unexplained anion and osmol gaps, early diagnosis and therapy with ethanol and hemodialysis help. Challenges in the diagnosis of ethylene glycol poisoning. This report highlights the importance of including ethylene glycol toxicosis. Ethylene glycol is a synthetic liquid substance that absorbs water. Odor does not provide any warning of hazardous concentrations. Other pertinent literature is also presented, but is described in less detail than the key studies. One patient was protected from the toxic effects of the metabolites because of concomitant ethanol ingestion. Ntpcerhr monograph on the potential human reproductive. Ethylene glycol industrial ethylene glycol meglobal glycol solv ethylene glycol, section 4. If untreated, severe ethylene glycol toxicity is usually fatal within 24 to 36 hours. Show this safety data sheet to the doctor in attendance. Ethylene glycol is widely used to inhibit the formation of natural gas clathrates hydrates in long multiphase pipelines that convey natural gas from remote gas fields to a gas processing facility.
Department of health and human services, public health service. The toxicology of glycol ethers and its relevance to man. Pdf the ingestion of ethylene glycol results in toxicity with characteristic chemical, pathological, and imaging findings. Outcome of patients in acute poisoning with ethylene glycol. Propylene glycol, which is much less toxic than ethylene glycol, is metabolized to compounds that. Brent j, mcmartin k, phillips s, burkhart kk, donovan jw, wells m, et al. Ethylene glycol toxicosis in a freeranging raccoon.
Diethylene glycol deg ethylene glycol eg application note. The mortality rate of ethylene glycol intoxication ranges between 1 and 22% depending on the amount of alcohol ingestion and the time period between the alcohol ingestion and the initiation of therapy 1,2. Identification product name ethylene glycol cat no. How is ethanol used in the treatment of ethylene glycol toxicity. Fatalities associated with ingestion of diethylene glycol. Ethylene glycol ingestion is a medical emergency requiring prompt recognition and aggressive treatment. After ingestion, ethylene glycol is rapidly absorbed within 1 to 4 hours through the stomach. Ethylene glycol poisoning in cats vetlexicon felis from.
Propylene glycol 1,2propanediol is the solvent used to deliver lorazepam and diazepam iv. Due to its demand and a vast application area lot of research is going on for improving its production statistics. How is 4methylpyrazole used in the treatment of ethylene glycol toxicity. Ethylene glycol eg is a small, hydroxysubstituted hydrocarbon with the chemical formula c 2 h 6 o 2 and the structure shown in figure 1. Direct eg quantification methods involve cumbersome and timeconsuming laboratory tests of limited utility in the emergency setting. Later symptoms may include a decreased level of consciousness, headache, and seizures. Removes ethylene glycol and glycolate effectively indications. The effects of these substances, except for isopropanol and possibly alcoholic ketoacidosis, are due to. Often implicated in cases of malicious poisoning in cats.
Ethylene glycol poisoning, while uncommon, is clinically significant due to the associated. An online veterinary manual provides information on lethal doses of ethylene glycol for. Safety data sheet creation date 02feb2010 revision date 17jan2018 revision number 4 1. Ethylene glycol toxicosis in a freeranging raccoon procyon.
Ethylene glycol eg is an odorless, electrically neutral polyalcohol and a common solvent for antifreeze solutions, brake fluids, and household industrial products. Ethylene oxide reacts with water to produce ethylene glycol according to the chemical equation. Ethylene glycol, a sweettasting, odorless liquid, is the active ingredient in antifreeze. Pdf current management of ethylene glycol poisoning. Sep 26, 2019 agency for toxic substances and disease registry atsdr. Although less toxic than eg, ingestion of propylene glycol pg may be associated with a toxic syndrome similar to the acute phase of eg toxicosis. Excessive exposure swallowing large amounts may cause. Acidbase measurement and calculated osmolar gap often are. Ethylene glycol is a clear, odorless, slightly viscous liquid. Loading dose is 15mgkg in 100 mls of ns or d5w infused over 30 minutes next 10mgkg every 12 hours for two days next 15mgkg every 12 hours until the ethylene glycol level is less than 2 and pt. A acute methanol toxicity b acute isopropanol toxicity c acute ethylene glycol toxicity d acute iron toxicity rate of elimination mgdlhour of ethanol is.
Accordingly, the osmolal gap is frequently employed as a surrogate screening method in cases of suspected. Ethylene glycol concentration500mgl or presence of severe metabolic acidosis, renal failure, severe electrolyte imbalance, or generally deteriorating. An integrated perspective on the developmental toxicity of ethylene glycol. Please note that the layout and pagination of this pdf file are not necessarily identical to the.
Ethylene glycol eg poisoning is a toxicologic emergency requiring high clinical suspicion and early diagnosis to prevent lifethreatening complications. Ethylene glycol can also be found, in lower concentrations, in some windshield deicing agents, hydraulic brake fluid, motor oils, solvents, paints, film processing solutions, wood stains, inks, printer cartridges, etc. This report highlights the importance of including ethylene glycol toxicosis on the list of differential diagnoses for abnormal mentation and seizures in freeranging raccoons. System rfd mgkgday basis pod composite uf confidence. Eg is used as a chemical intermediate in the production of polyester compounds. These 95% commercial antifreeze preparations are diluted 50% with water when used in vehicle cooling systems. Ethylene glycol ingestion results initially in cns effects. The sweet taste, low cost, and intoxicating effects of eg lead to its illicit use as an ethanol substitute. Cureus ethylene glycol toxicity in the setting of recurrent. A juvenile freeranging raccoon procyon lotor was presented for acute onset of abnormal mentation and seizures.
Benzodiazepines are commonly administered to medical icu micu patients. After a characteristic latent period, signs of inebriation may be followed by serious illness, and even death, caused by toxic metabolites propylene glycol, which is much less toxic than ethylene glycol, is metabolized to compounds that are normal constituents of the citric acid cycle no health effects have been reported in. Safety and efficacy of high dose fomepizole as therapy for ethylene glycol intoxication in cats abstract. Ethylene glycol industrialethylene glycol meglobalglycolsolv ethylene glycol, section 4. Gcms analysis of diethylene glycol and ethylene glycol in. Most intoxications are associated with ingestion of antifreeze, which is typically 95% eg.
Overview of ethylene glycol toxicity toxicology merck. Anccsglycol preparation of samples the sample preparation was carried out according to the fda method1. Sep 22, 2015 ethylene glycol toxicosis is a type of poisoning that occurs in dogs after ingestion of antifreeze or other fluids containing the ingredient ethylene glycol. Ethylene glycol eg toxicity extended version beloved pets drink from puddles. Ethylene glycol is used to make antifreeze and deicing solutions for cars, airplanes, and boats.
Long term outcomes may include kidney failure and brain damage. All animals are susceptible to ethylene glycol eg toxicity, but it is most common in dogs and cats. Ethylene glycol, also called 1,2ethanediol, is a viscous liquid with a sweet taste. Ethanol administration may be discontinued if ethylene glycol concentrations can no longer be detected or are less than 3. Ethylene glycol toxicosis was diagnosed on postmortem examination. Branded toothpaste was obtained from a local pharmacy. The actual clinical presentation changes over time as intoxication evolves.
It is also used in hydraulic brake fluids and inks used in stamp pads, ballpoint pens, and print shops. Preliminary evaluation of a quantitative ethylene glycol test. Oh this reaction can be catalyzed by either acids or bases, or can occur at neutral ph under elevated temperatures. The toxicology of glycol ethers and its relevance to man ecetoc tr no. Challenges in the diagnosis of ethylene glycol poisoning david j. A paper on manufacturing of ethylene glycol ethylene glycol is nowadays one of the most industrially important chemical. The ingested amount of ethylene glycol required to produce toxicity in animals is approximately 1 to 1. Propylene glycol toxicosis toxicology merck veterinary manual. Propylene glycol toxicosis toxicology merck veterinary. Uses advised against not for food, drug, pesticide or biocidal product use details of the supplier of the safety data sheet emergency telephone number chemtreco, inside the usa. Comparison of the effects of ethanol and 4methylpyrazole on the pharmacokinetics and toxicity of ethylene glycol in the dog. After a characteristic latent period, signs of inebriation may be followed by serious illness, and even death, caused by toxic metabolites. All atsdr toxicological profile pdf files are electronic conversions from paper copy or other electronic ascii text files. Alcoholrelated intoxications, including methanol, ethylene glycol, diethylene glycol, and propylene glycol, and alcoholic ketoacidosis can present with a high anion gap metabolic acidosis and increased serum osmolal gap, whereas isopropanol intoxication presents with hyperosmolality alone.
Early and late presentations of ethylene glycol poisoning. Due to the solutes depression of the freezing point of water. Ethylene glycol is a very useful industrial compound because of its low freezing point and high boiling point. For samples containing ethylene glycol, the difference between the 2 determinations is minimal. Oral toxicity is expected to be moderate in humans due to ethylene glycol even though tests with animals show a lower degree of toxicity. While ethylene glycol itself causes intoxication, the accumulation of toxic. Outcome of patients in acute poisoning with ethylene. Application of a dead volume free, very fast deans heartcut. Safety and efficacy of high dose fomepizole as therapy for ethylene glycol intoxication in. In 1995 the world capacity for ethylene glycol was about 9. Ethylene glycol poisoning an overview sciencedirect topics.
Ethylene glycols egs represent a series of synthetic organic linear oligomers of increasing oxyethylene units per molecule with the general molecular formula hoch 2 ch 2 n oh, where n is an integer in the range 15. Cns effects predominate and include inebriation without the alcohol odor on the breath, slurred speech, drowsiness, somnolence, hypotonia, hyporeflexia, ataxia, myoclonic jerks, and gastrointestinal upset. Although ethylene glycol itself has relatively low toxicity, it is metabolized in the liver to a variety of toxic compounds figure 1, some of which have elimination halflives of up to 12 hours. Ethylene glycol itself is not toxic, but it is metabolized in the animals body to several extremely toxic chemicals that are responsible for its potentially lethal effects.
Signs and symptoms depend on the amount ingested and concurrent use of alcohol. Following absorption, 80% or more of ethylene glycol is chemically converted by the body into toxic compounds. It is a colorless, odorless, and sweettasting solution. Ethylene glycol classically produces an elevated anion gap metabolic acidosis. We report a series of patients with ethylene glycol toxicity with a component of nonanion gap metabolic acidosis without known associated confounding factors.
The atsdr toxicological profile succinctly characterizes the toxicologic and adverse health effects information for the hazardous substance described here. Ethylene glycol intoxication is uncommon, but can result in lifethreatening metabolic acidosis, kidney failure, and death. These substances are high production volume substances that are produced by the hydrolysis of ethylene oxide followed by distillation to separate the individual glycols. Ethylene glycol toxicosis is a type of poisoning that occurs in dogs after ingestion of antifreeze or other fluids containing the ingredient ethylene glycol. Oct 21, 2014 ethylene glycol is a clear, odorless, slightly viscous liquid with a sweet taste. Ethylene glycol toxicity presenting with nonanion gap. The course of ethylene glycol toxicity is classically divided into three broad overlapping categories of adverse health effects. Dog, acute onset lethargy, disorientation, vomiting, seizures.
Ethanol coingestion roughly doubles ethylene glycol halflife. Ethylene glycol is an inexpensive, readily available substance that may be associated with accidental or intentional toxicity. In cats, ingestion of a diet containing 6%12% pg can result in heinz body formation and decreased rbc survival. Two cases of ethylene glycol poisoning associated with serum concentrations of 59 and 150 mgdl are reported. Ethylene glycol occurs as a clear, slightly viscous liquid that is completely miscible with water. Diagnosing such poisoning can be problematic in the absence of a clear history of ingestion, especially in patients who present with altered mental status or those who deny such consumption. Although propylene glycol toxicity is increasingly recognized and reported, its incidence is unknown. Follow the diagnostic tree for evaluating ataxia in suspected ethylene glycol toxicity evaluating ataxia in suspected ethylene glycol toxicity. The chemical formula for ethylene glycol is c 2 h 6 o 2, and its molecular weight is 62. Early symptoms include intoxication, vomiting and abdominal pain. Pdf ethylene glycol, a common antifreeze, coolant and industrial solvent, is responsible for many instances of accidental and intentional poisoning. Ethylene glycol poisoning in dogs vca animal hospital.
Uses advised against not for food, drug, pesticide or biocidal product use details of the supplier of the safety data sheet. Ethylene glycol can be recovered from the natural gas and reused as an inhibitor after purification treatment that removes water and inorganic salts. The ratelimiting step in this metabolic process is the conversion of ethylene glycol to glycoaldehyde. Increased osmolal gap with a detectable serum ethylene glycol level is.