Calcium oxalate crystals in the urine, acidosis or increased osmol gap in the blood[1]
Treatment
Antidote, hemodialysis[2]
Medication
Fomepizole, ethanol[2]
Frequency
> 5,000 cases per year (US)[3]
Ethylene glycol poisoning is poisoning caused by drinking ethylene glycol.[1] Early symptoms include intoxication, vomiting and abdominal pain.[1] Later symptoms may include a decreased level of consciousness, headache, and seizures.[1] Long term outcomes may include kidney failure and brain damage.[1] Toxicity and death may occur after drinking even in a small amount[1] as ethylene glycol is more toxic than other diols.
Ethylene glycol is a colorless, odorless, sweet liquid, commonly found in antifreeze.[1] It may be drunk accidentally or intentionally in a suicide attempt.[2] When broken down by the body it results in glycolic acid and oxalic acid which cause most of the toxicity.[1][4] The diagnosis may be suspected when calcium oxalate crystals are seen in the urine or when acidosis or an increased osmol gap is present in the blood.[1] Diagnosis may be confirmed by measuring ethylene glycol levels in the blood; however, many hospitals do not have the ability to perform this test.[1]
Early treatment increases the chance of a good outcome.[2] Treatment consists of stabilizing the person, followed by the use of an antidote.[2] The preferred antidote is fomepizole with ethanol used if this is not available.[2] Hemodialysis may also be used in those where there is organ damage or a high degree of acidosis.[2] Other treatments may include sodium bicarbonate, thiamine, and magnesium[clarification needed].[2]
More than 5,000 cases of poisoning occur in the United States each year.[3] Those affected are often adults and male.[4] Deaths from ethylene glycol have been reported as early as 1930.[5] An outbreak of deaths in 1937 due to a medication mixed in a similar compound, diethylene glycol, resulted in the Food, Drug, and Cosmetic Act of 1938 in the United States, which mandated evidence of safety before new medications could be sold.[5] Antifreeze products sometimes have a substance to make them bitter added to discourage drinking by children or animals but this has not been found to be effective.[2]
^ abcdefghijklmnKruse, JA (October 2012). "Methanol and ethylene glycol intoxication". Critical Care Clinics. 28 (4): 661–711. doi:10.1016/j.ccc.2012.07.002. PMID 22998995.
^ abcdefghiBeauchamp, GA; Valento, M (September 2016). "Toxic Alcohol Ingestion: Prompt Recognition And Management In The Emergency Department". Emergency Medicine Practice. 18 (9): 1–20. PMID 27538060.
^ abNaidich, Thomas P.; Castillo, Mauricio; Cha, Soonmee; Smirniotopoulos, James G. (2012). Imaging of the Brain: Expert Radiology Series. Elsevier Health Sciences. p. 960. ISBN 978-0323186476. Archived from the original on 2017-09-08.
^ abFerri, Fred F. (2016). Ferri's Clinical Advisor 2017: 5 Books in 1. Elsevier Health Sciences. p. 794. ISBN 9780323448383. Archived from the original on 2017-09-08.
^ abShaw, Leslie M. (2001). The Clinical Toxicology Laboratory: Contemporary Practice of Poisoning Evaluation. Amer. Assoc. for Clinical Chemistry. p. 197. ISBN 9781890883539. Archived from the original on 2017-09-08.
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